[Significance of intraoperative precise management on intracavitary treatment for pulmonary thromboembolism].

OBJECTIVE: To compare cardiac adverse events, clinical outcomes and mid-and-long-term effects among massive and sub-massive pulmonary embolism (PE) patients under different periodswho received thrombus fragmentation by pigtail catheter.

METHODS: Two groups of patients who receivedthrombusfragmentation bypigtail catheter in different periods were analyzed retrospectively. Group E: 38 cases received therapy from July 2004 to October 2009 with local anesthesia; Group P: 64 cases with general anesthesia from March 2010 to December 2014. All patients were confirmedPEby CT and angiography. Parts of patients with deep vein thrombosis (DVT) received inferior vena cava filter placement 3 days later. The patients were followed up for 6-24 months after discharge. Cardiac adverse events, clinical outcomes during the thrombusfragmentation process, and mid-and-long-term effects were compared between the two groups.

RESULTS: There were no significant differences in preoperative clinical data betweenthe two groups (P>0.05). Compared with group E, clinical warning events were significantly improved in group P (odds ratio(OR): 1.24, 98.3, 1.45, 2.50; P<0.05). Within group P, there were significant differences inarterial oxygen partial pressure (PaO2) [(98.3±8.7)vs(81.3±7.1)], mean pulmonary artery pressure (mPAP) [(25.3±7.9)vs(37.2±7.6)], heart rate (HR) [(94.3±7)vs(122±9)], airway resistance [(16.7±1.6)vs (22.5±2.1)] and mean arterial pressure (MAP) [(53.4±7)vs(42.5±6)] before and after thrombus fragmentationtreatment (P<0.05). The incidence of congestive heart failure and pulmonary arterial hypertension associated with chronic pulmonary thromboembolism (CPEPH) during follow-up were significantly different between group P andgroup E (P<0.05).

CONCLUSION: Thrombus fragmentation by pigtail catheter with intraoperativeprecise management under general anesthesia can reduce cardiac adverse events andimprove the mid-and-long-term effects among PE patients.