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Vol 81, Supp. I (2023): Zeszyty Edukacyjne 1/2023
Opinie i stanowiska ekspertów
Published online: 2023-09-27

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Rola terapii przezcewnikowych w leczeniu ostrej zatorowości płucnej — opinia Polskiej Inicjatywy PERT, Sekcji Krążenia Płucnego, Asocjacji Interwencji Sercowo-Naczyniowych i Asocjacji Intensywnej Terapii Kardiologicznej Polskiego Towarzystwa Kardiologicznego

Grzegorz Kopeć12, Aleksander Araszkiewicz3, Marcin Kurzyna4, Sylwia Sławek-Szmyt3, Jakub Stępniewski125, Marek Roik6, Szymon Darocha4, Marek Gołębiowski7, Miłosz Jaguszewski8, Stanisław Jankiewicz3, Marta Kałużna-Oleksy3, Wiktor Kuliczkowski9, Ewa Lewicka10, Tatiana Mularek-Kubzdela3, Arkadiusz Pietrasik11, Marcin Protasiewicz9, Roman Przybylski12, Paweł Pleskot7, Agnieszka Tycińska13, Dariusz Zieliński14, Piotr Podolec215, Przemysław Trzeciak16, Marek Grygier3, Ewa Mroczek17, Piotr Pruszczyk6
DOI: 10.33963/v.kp.96986

Abstract

Dzięki postępom w zakresie technologii kardiologii interwencyjnej leczenie przezcewnikowe stało się w ostatnich latach realną opcją terapeutyczną w leczeniu pacjentów z ostrą zatorowością płucną z wysokim ryzykiem wczesnej śmiertelności. Obecnie stosowane techniki przezcewnikowe umożliwiają miejscową fibrynolizę lub embolektomię przy minimalnym ryzyku powikłań. Stąd mogą być rozważane u pacjentów z grupy wysokiego ryzyka jako alternatywa dla chirurgicznej embolektomii płucnej, gdy systemowa tromboliza jest przeciwwskazana lub nieskuteczna. Rozważane są również u pacjentów z grupy średniego–wysokiego ryzyka, u których pomimo leczenia przeciwzakrzepowego nie uzyskano poprawy lub nastąpiło pogorszenie stanu klinicznego.
Celem artykułu było przedstawienie roli technik przezcewnikowych w leczeniu chorych z ostrą zatorowością płucną zgodnie z aktualną wiedzą i opinią ekspertów. Leczenie interwencyjne opisano w szerszym kontekście organizacji opieki nad pacjentem. Przedstawiono organizację i zadania zespołu szybkiego reagowania w zatorowości płucnej, rolę obrazowania przedzabiegowego, zasady antykoagulacji okołozabiegowej, kryteria kwalifikacji pacjentów, wyboru odpowiedniego czasu interwencji oraz rolę intensywnej terapii. Szczegółowo omówiono dostępne terapie przezcewnikowe, w tym wystandaryzowane protokoły, definicje sukcesu i niepowodzenia procedury. Niniejszy dokument został opracowany we współpracy z ekspertami z różnych polskich towarzystw naukowych, co podkreśla rolę pracy zespołowej w opiece nad chorym z ostrą zatorowością płucną.

Keywords: embolektomia płucnafibrynoliza lokalnaintensywna terapialeczenie interwencyjnenieskuteczność antykoagulacjinieskuteczność systemowej trombolizyostra zatorowość płucnaPERTtechniki przezcewnikowetechniki przezskórne

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