中央位置,尺寸,鞍性肺栓塞(SPE)的不稳定性引起了人们对其临床的重大关注,血液动力学影响以及最佳管理。肺栓塞(PE)指南几乎没有解决这些问题。我们旨在汇集有关SPE的临床行为和结果的可用数据,并研究各种治疗方式对死亡率结果的影响。
PubMed,Scopus,和GoogleScholar搜索了报告SPE患者的文章(截至2022年2月28日的任何日期)。SPE人口统计数据,临床特征,管理,并对结果进行提取和分析。
来自所有SPE病例的结果:来自194项研究的5251名患者被纳入该综述。呼吸困难(57%)是最常见的症状。大面积和块状PE分别占9.7%和45.8%,分别。溶栓治疗(TT)占18.1%,16%的病例进行了血栓切除术。SPE相关死亡率为4.6%,晚期失代偿率为9.5%,和PE复发在4.5%的病例。女性(61.5%vs.41.3%,p=0.019),低氧血症(90%vs.59.2%,p<0.001),大量的PE功能(89.7%与30.1%,p<0.001),相关慢性肾脏病(CKD)(10.3%vs.1.4%,p=0.002),以及机械通气的需要(28.2%vs.13.1%,p=0.02)与死亡率增加显著相关。TT的使用与生存率的增加显着相关(27.1%vs.12.5%,p<0.001)。在多元逻辑回归模型中,大量PE特征显著增加死亡几率(OR:29.3,CI:4.86-181.81,p<0.001),然而,单用抗凝治疗(AC)(OR:0.1,CI:0.027-0.356,p<0.001),TT(OR:0.065,CI:0.019-0.26,p<0.001),外科血栓切除术(ST)(OR:0.047,CI:(0.010-0.23),p<0.001),或经皮血栓切除术(PT)(OR:0.12,CI:0.020-0.84,p=0.032)显着降低了死亡几率。对观察性研究的荟萃分析结果:对纳入的17项观察性研究的荟萃分析显示,在所有PE病例中,SPE的总体患病率为10%(95%CI:4.56-16.89)。总体SPE相关死亡率为8%(95%CI:5.26-10.96)。在13.3%(95%CI:5.56-23.70)中观察到大量PE,PE复发率为5.1%(95%CI:2.22-9.05),11%(95%CI:3.43-22.34)的患者晚期失代偿。
SPE占所有PE病例的10%。尽管它不祥的放射学外观,临床,血液动力学,SPE的死亡率结果似乎与其他类型的PE相当。大量PE特征的存在是SPE患者死亡率的主要预测因素。AC,TT,ST,和PT都与SPE死亡几率降低有关。
The central location, size, and instability of saddle pulmonary embolism (SPE) have raised significant concerns regarding its clinical, hemodynamic effects as well as optimal management. Pulmonary embolism (PE) guidelines barely address such concerns. We aimed to pool the available data on the clinical behavior and outcomes of SPE and study the effects of various treatment modalities on mortality outcomes.
PubMed, Scopus, and Google Scholar were searched for articles (any date up to February 28, 2022) reporting patients with SPE. Data on SPE demographics, clinical characteristics, management, and outcomes were extracted and analyzed.
Results from all SPE cases: A total of 5251 patients from 194 studies were included in the review. Dyspnea (57 %) was the most prevalent symptom. Massive and submassive PE comprised 9.7 % and 45.8% of cases, respectively. Thrombolytic therapy (TT) was administered in 18.1 %, and thrombectomy was performed in 16 % of cases. SPE-related mortality was observed in 4.6 %, late decompensation in 9.5 %, and PE recurrence in 4.5 % of cases. Female sex (61.5 % vs. 41.3 %, p = 0.019), hypoxemia (90 % vs. 59.2 %, p < 0.001), massive PE features (89.7 % vs. 30.1 %, p < 0.001), associated chronic kidney disease (CKD) (10.3 % vs. 1.4 %, p = 0.002), and the need for mechanical ventilation (28.2 % vs. 13.1 %, p = 0.02) were significantly associated with increased mortality. The use of TT was significantly associated with increased survival (27.1 % vs. 12.5 %, p < 0.001). In a multivariate logistic regression model, massive PE features significantly increased the odds of death (OR: 29.3, CI: 4.86-181.81, p < 0.001), whereas, treatment with anticoagulation (AC) alone (OR: 0.1, CI: 0.027-0.356, p < 0.001), TT (OR: 0.065, CI: 0.019-0.26, p < 0.001), surgical thrombectomy (ST) (OR: 0.047, CI: (0.010-0.23), p < 0.001), or percutaneous thrombectomy (PT) (OR: 0.12, CI: 0.020-0.84, p = 0.032) significantly decreased odds of death. Results from a meta-analysis of observational studies: Meta-analysis of the included 17 observational studies revealed an overall 10 % (95 % CI: 4.56-16.89) SPE prevalence among all PE cases. The overall SPE-related mortality rate was 8 % (95 % CI: 5.26-10.96). Massive PE was observed in 13.3 % (95 % CI: 5.56-23.70), PE recurrence in 5.1 % (95 % CI: 2.22-9.05), and late decompensation in 11 % (95 % CI: 3.43-22.34) of patients.
SPE comprises 10 % of all PE cases. Despite its ominous radiologic appearance, the clinical, hemodynamic, and mortality outcomes of SPE seem comparable to that of other PE types in general. The presence of massive PE features is the main predictor of mortality in SPE patients. AC, TT, ST, and PT are all associated with decreased odds of death from SPE.