ĐẶC ĐIỂM BỆNH NHÂN THUYÊN TẮC PHỔI ĐƯỢC ĐIỀU TRỊ THUỐC TIÊU SỢI HUYẾT TẠI VIỆN TIM MẠCH BỆNH VIỆN BẠCH MAI

Abstract

Objectives: To study of clinical and paraclinical characteristics of of patients with pulmonary embolism (PE) and their impact on the results of treatment with the thrombolytic drug alteplase. Subjects and methods: Study the medical records of 52 pts with acute PE from October 2019 to April 2025 treated with alteplase thrombolytic drug at the Cardiovascular Institute, Bach Mai Hospital. Results: 17 male and 35 female pts (67%) with an average age of 61 ± 18 years, all had an sPESI score ≥ 1 point (38% of pts had 2 points, 15% of pts had 3 points). 28 pts were at high risk (53.9%), 24 pts were at medium-high risk. 37 pts (71.2%) had good progress and were discharged, 15 pts (28.8%) had severe progress (died, untreatable due to severity). The most common clinical symptoms were dyspnea (94%), chest pain (75%), tachycardia > 100 beats/minute (73%), rapid breathing >20/minute (46%), SpO2 < 90% (46%), systolic blood pressure < 90 mmHg (31%). 100% of pts required respiratory support upon admission (65.4% received oxygen via nasal cannula, 32.7% required invasive mechanical ventilation, 1.9% required non-invasive mechanical ventilation). On electrocardiogram, 58% of pts had S1Q3T3 pattern, 50% had inverted T waves in the precordial leads. On echocardiogram, 33% of pts had right ventricular/left ventricular ratio >1 and 15% had thrombus detected in the right heart chamber. 94% of pts had deep vein thrombosis of the lower extremities. 100% of pts had hs troponin T > 0.1 ng/mL and NT-ProBNP > 500 pg/mL. Patients with severe progression were often high-risk PE pts (87%), severe respiratory failure on admission (SpO2 < 90%), requiring invasive mechanical ventilation (93%), and the right ventricle/left ventricle ratio > 1 (87%). Conclusion: Patients with acute PE treated with thrombolytics were both high-risk and intermediate-high risk. Patients with severe progression were often severe respiratory failure, requiring invasive mechanical ventilation, and had severe right ventricular hypertrophy on echocardiography.