经导管介入治疗在中高危肺栓塞中的应用现状
Current Status of Catheter-Directed Intervention for Intermediate-High-Risk Pulmonary Embolism
摘要: 急性中高危肺栓塞(pulmonary embolism, PE)患者具有显著的短期死亡风险及血流动力学失代偿风险。传统抗凝治疗对于快速解除右心室负荷效果有限，而系统性溶栓则面临较高的大出血风险。近年来，经导管介入治疗(catheter-directed intervention, CDI)作为一种微创再灌注策略，在中高危肺栓塞的管理中展现出重要价值。本文综述了导管导向溶栓(catheter-directed thrombolysis, CDT)与机械取栓(mechanical thrombectomy, MT)等关键技术的分类及其临床特点，对比了介入治疗与标准抗凝治疗在疗效与安全性方面的循证证据，并探讨了介入治疗对患者长期功能恢复及生活质量的影响。目前随机对照试验(randomized controlled trial, RCT)初步证实了CDI在改善右心室功能方面的优势，但其对长期生存获益等硬终点的影响仍有待大规模研究进一步验证。多学科肺栓塞响应团队(Pulmonary Embolism Response Team, PERT)的协作对于优化治疗决策至关重要。
Abstract: Patients with acute intermediate-high-risk pulmonary embolism (PE) face significant risks of short-term mortality and hemodynamic decompensation. Traditional anticoagulation has limited efficacy in rapidly reversing right ventricular (RV) pressure overload, while systemic thrombolysis is associated with a substantial risk of major bleeding. In recent years, catheter-directed intervention (CDI) has emerged as a crucial minimally invasive reperfusion strategy for managing intermediate-high-risk PE. This article reviews the classification and clinical characteristics of key technologies, including catheter-directed thrombolysis (CDT) and mechanical thrombectomy (MT). It compares evidence regarding the efficacy and safety of CDI versus standard anticoagulation and discusses the impact of CDI on long-term functional recovery and quality of life. While current randomized controlled trials (RCT) support the superiority of CDI in improving RV function, its impact on “hard” clinical endpoints such as long-term survival requires further validation through large-scale studies. The collaboration of multidisciplinary Pulmonary Embolism Response Teams (PERT) is essential for optimizing treatment decisions.
文章引用：刘嘉舟, 王晓慧, 陈虹. 经导管介入治疗在中高危肺栓塞中的应用现状[J]. 临床医学进展, 2026, 16(5): 1276-1283. https://doi.org/10.12677/acm.2026.1651928

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