emcardioНеотложная кардиология и кардиоваскулярные рискиEmergency Cardiology and Cardiovascular Risks journal2616-633XБелорусский государственный медицинский университетemcardio-299Research ArticleОбзоры и лекцииReviews and lecturesЛечение массивной тромбоэмболии легочной артерии на современном этапеCurrent Treatment of Massive Pulmonary ThromboembolismСтаткевичТ. В.StatkevichT. V.ПатеюкИ. В.PatsiayukI. V.ИльинаТ. В.IlinaT. V.ДемидовичД. В.DemidovichD. V.ЯнуковичА. С.YanukovichA. S.МитьковскаяН. П.MitkovskayаN. P.Белорусский государственный медицинский университетBelarusian State Medical UniversityГосударственное учреждение «Республиканский научно-практический центр «Кардиология»Scientific and Practical Centre «Cardiology»Учреждение здравоохранения «Городская клиническая больница скорой медицинской помощи»Minsk City Emergency HospitalУчреждение здравоохранения «Солигорская центральная районная больница»Soligorsk Central Regional Hospital201715112025114652Copyright © Статкевич Т.В., Патеюк И.В., Ильина Т.В., Демидович Д.В., Янукович А.С., Митьковская Н.П., 20252025Статкевич Т.В., Патеюк И.В., Ильина Т.В., Демидович Д.В., Янукович А.С., Митьковская Н.П.Statkevich T.V., Patsiayuk I.V., Ilina T.V., Demidovich D.V., Yanukovich A.S., Mitkovskayа N.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://emcardio.bsmu.by/jour/article/view/299

Массивная тромбоэмболия легочной артерии остро возникающее, тяжелое заболевания, в основе которого лежит окклюзия главных легочных артерий с редукцией более 60% легочного кровотока тромботическими массами. Клиническая картина заболевания связана с возникновением тяжелых нарушений легочной и системной гемодинамики и проявляется развитием артериальной гипотензии или шока. Смертность в первые часы заболевания достигает 68%, что позволяет тромбоэмболии легочной артерии занимать третье место среди самых распространённых причин смерти, уступая лишь инфаркту миокарда и нарушениям мозгового кровообращения.

Massive pulmonary embolism is an acute, severe disease, which is based on the occlusion of the main pulmonary arteries with a reduction of more than 60% of pulmonary blood flow by thrombotic masses. The clinical presentation of the disease is associated with the occurrence of severe disorders of pulmonary and systemic hemodynamics andis manifested by the development of arterial hypotension or shock. Mortality in the first hours of the disease reaches 68%, which allows pulmonary embolism rank third among the most common causes of death, second only to myocardial infarction and stroke. Effective therapy using all available current techniques can help improve the prognosis and survival of this category of patients.

тромбоэмболия легочной артериимассивная тромбоэмболия легочной артериивенозная тромбоэмболиялечение тромбоэмболии легочной артерииpulmonary embolismmassive pulmonary embolismvenous thromboembolismpulmonary embolism treatmentReferencesKirienko A. I., Chernyavskiy A. M., Andryashkina V. V. red. Tromboemboliyalegochnych artery. Kaklechit'ipredotvraschat [Thromboembolism of pulmonary arteries. How to treat and prevent]. M.: Medizinskoe informazionnoe agentstvo, 2015, 275 s. (in Russian).Kirienko A. I., Chernyavskiy A. M., Andryashkina V. V. red. Tromboemboliyalegochnych artery. Kaklechit'ipredotvraschat [Thromboembolism of pulmonary arteries. How to treat and prevent]. M.: Medizinskoe informazionnoe agentstvo, 2015, 275 s. (in Russian).Righini M., Robert-Ebadi H., Le Gal G. Diagnosis of pulmonary embolism. PresseMed, 2015, vol. 44, no. 12, pp. 385-391.Righini M., Robert-Ebadi H., Le Gal G. Diagnosis of pulmonary embolism. PresseMed, 2015, vol. 44, no. 12, pp. 385-391.Pyko A. A., Grigorenko E. A., Statkevich T. V., Pyko A. V., Mukalova O. A., Mit'kovskaya N. P Vnezapnaya serdechnaya smert': epidemiologicheskie aspekty, vozmozhnosti profilakticheskich technologiy [Sudden cardiac death: epidemiological aspects, the possibilities of preventive technologies]. Kardiologiya v Belarusi, 2016, № 4, S. 534-553. (in Russian).Pyko A. A., Grigorenko E. A., Statkevich T. V., Pyko A. V., Mukalova O. A., Mit'kovskaya N. P Vnezapnaya serdechnaya smert': epidemiologicheskie aspekty, vozmozhnosti profilakticheskich technologiy [Sudden cardiac death: epidemiological aspects, the possibilities of preventive technologies]. Kardiologiya v Belarusi, 2016, № 4, S. 534-553. (in Russian).Laporte S., MismettiP, Decousus H., Uresandi F.,Otero R., Lobo J. L., Monreal M. Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry. Circulation, 2008, vol. 117, no. 13, P 1711-1716.Laporte S., MismettiP, Decousus H., Uresandi F.,Otero R., Lobo J. L., Monreal M. Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry. Circulation, 2008, vol. 117, no. 13, P 1711-1716.Monreal M., Mahe I., Bura-Riviere A., Prandoni P, Verhamme P, Brenner B., Wells P S., Di Micco P, Bertoletti L. Pulmonary embolism: Epidemiology and registries. Presse Med, 2015, vol. 44, no. 12, pp. 377-383.Monreal M., Mahe I., Bura-Riviere A., Prandoni P, Verhamme P, Brenner B., Wells P S., Di Micco P, Bertoletti L. Pulmonary embolism: Epidemiology and registries. Presse Med, 2015, vol. 44, no. 12, pp. 377-383.Meyer, G. Effective diagnosis and treatment of pulmonary embolism: Improving patient outcomes. Arch Cardiovascular Disease, 2014, vol. 107, no.6-7, pp. 406-414.Meyer, G. Effective diagnosis and treatment of pulmonary embolism: Improving patient outcomes. Arch Cardiovascular Disease, 2014, vol. 107, no.6-7, pp. 406-414.Konstantinides S. V. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J, 2014, vol. 53, no. 45, pp. 3145-3146.Konstantinides S. V. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J, 2014, vol. 53, no. 45, pp. 3145-3146.Piran, S., Schulman S. Management of venous thromboembolism: an update. Thromb J, 2016, vol. 4, no. 14, pp. 107-115.Piran, S., Schulman S. Management of venous thromboembolism: an update. Thromb J, 2016, vol. 4, no. 14, pp. 107-115.Turan O., Turgut D., Gunay T., Yilmaz E., Turan A., Akkoclu A. The contribution of clinical assessments to the diagnostic algorithm of pulmonary embolism. Adv Clin Exp Med, 2017, vol. 26, no. 2, pp. 303-309.Turan O., Turgut D., Gunay T., Yilmaz E., Turan A., Akkoclu A. The contribution of clinical assessments to the diagnostic algorithm of pulmonary embolism. Adv Clin Exp Med, 2017, vol. 26, no. 2, pp. 303-309.Vedantham S., Piazza G., Sista A. K., Goldenberg N. A. Guidance for the use of thrombolytic therapy for the treatment of venous thromboembolism. J Thromb Thrombolysis, 2016, vol. 41, no. 1, pp. 68-80.Vedantham S., Piazza G., Sista A. K., Goldenberg N. A. Guidance for the use of thrombolytic therapy for the treatment of venous thromboembolism. J Thromb Thrombolysis, 2016, vol. 41, no. 1, pp. 68-80.Statkevich T. V., Levkovich I. E., Kerko E. M., Mit'kovskaya N. P. Sovremennyepodchodyk terapii tromboembolii legochnoy arterii [Modern approaches to therapy of thromboembolism of the pulmonary artery]. I Mezhdunarodnyy kongress kardiologov i terapevtov: sb. nauch. trud., Minsk, 2016 / pod red. N. P. Mit'kovskoy. Minsk, 2016, S. 286-290. (in Russian).Statkevich T. V., Levkovich I. E., Kerko E. M., Mit'kovskaya N. P. Sovremennyepodchodyk terapii tromboembolii legochnoy arterii [Modern approaches to therapy of thromboembolism of the pulmonary artery]. I Mezhdunarodnyy kongress kardiologov i terapevtov: sb. nauch. trud., Minsk, 2016 / pod red. N. P. Mit'kovskoy. Minsk, 2016, S. 286-290. (in Russian).Mao L., Tromeur C., Couturaud F. Anticoagulation after an acute pulmonary embolism. Presse Med, 2017, № 7-8, pp. 728-738.Mao L., Tromeur C., Couturaud F. Anticoagulation after an acute pulmonary embolism. Presse Med, 2017, № 7-8, pp. 728-738.Limbrey R., Howard L. Developments in the management and treatment of pulmonary embolism. Eur Respir Rev, 2015, vol. 24, no. 137, pp. 484-497.Limbrey R., Howard L. Developments in the management and treatment of pulmonary embolism. Eur Respir Rev, 2015, vol. 24, no. 137, pp. 484-497.Enea I., Roncon L., Gulizia M. M., Azzarito M., Becattini C., Bongarzoni A., Casazza F., Cuccia C., D'Agostino C., Rugolotto M., Vatrano M. ANMCO Position Paper: the use of non-vitamin K dependent new oral anticoagulant(s) in pulmonary embolism therapy and prevention. Eur Heart. J Suppl, 2017, vol. 19, Sup. D, pp. D293-D308.Enea I., Roncon L., Gulizia M. M., Azzarito M., Becattini C., Bongarzoni A., Casazza F., Cuccia C., D'Agostino C., Rugolotto M., Vatrano M. ANMCO Position Paper: the use of non-vitamin K dependent new oral anticoagulant(s) in pulmonary embolism therapy and prevention. Eur Heart. J Suppl, 2017, vol. 19, Sup. D, pp. D293-D308.Burnett A. E., Mahan C. E., Vazquez S. R., Oertel L. B., Garcia D. A., Ansell J. Guidance for the practical management of the direct oral anticoagulants (DOACs) in VTE treatment. J Thromb Thrombolysis, 2016, vol. 41, no. 1, pp. 206-232.Burnett A. E., Mahan C. E., Vazquez S. R., Oertel L. B., Garcia D. A., Ansell J. Guidance for the practical management of the direct oral anticoagulants (DOACs) in VTE treatment. J Thromb Thrombolysis, 2016, vol. 41, no. 1, pp. 206-232.Streiff M. B., Agnelli G., Connors J. M., Crowther M., Eichinger S., Lopes R., McBane R.D., Moll S., Ansell J. Guidance for the treatment of deep vein thrombosis and pulmonary embolism. J Thromb Thrombolysis, 2016, vol. 41, no. 1, pp. 32-67.Streiff M. B., Agnelli G., Connors J. M., Crowther M., Eichinger S., Lopes R., McBane R.D., Moll S., Ansell J. Guidance for the treatment of deep vein thrombosis and pulmonary embolism. J Thromb Thrombolysis, 2016, vol. 41, no. 1, pp. 32-67.Kearon, C., Akl E. A. Duration of anticoagulant therapy for deep vein thrombosis and pulmonary embolism. Blood, 2014, vol.123, no. 12, pp. 1794-1801.Kearon, C., Akl E. A. Duration of anticoagulant therapy for deep vein thrombosis and pulmonary embolism. Blood, 2014, vol.123, no. 12, pp. 1794-1801.Ryan, J. Pulmonary embolism: new treatments for an old problem. Open Access Emergency Medicine, 2016, vol. 8, pp. 87-95.Ryan, J. Pulmonary embolism: new treatments for an old problem. Open Access Emergency Medicine, 2016, vol. 8, pp. 87-95.Toth P. P. Considerations for long-term anticoagulant therapy in patients with venous thromboembolism in the novel oral anticoagulant era. Vascular Health and Risk Management, 2016, vol. 10, no. 12, pp. 23-34.Toth P. P. Considerations for long-term anticoagulant therapy in patients with venous thromboembolism in the novel oral anticoagulant era. Vascular Health and Risk Management, 2016, vol. 10, no. 12, pp. 23-34.Lavonas E. J., Drennan I. R., Gabrielli A., Heffner A. C., Hoyte C. O., Orkin A. M., Sawyer K. N., Donnino M. W. Part 10: special circumstances of resuscitation: 2015 American Heart Association Guidelines Update for CardiopulmonaryResuscitation and Emergency Cardiovascular Care. Circulation, 2015, vol. 41, no. 2, pp.501-518.Lavonas E. J., Drennan I. R., Gabrielli A., Heffner A. C., Hoyte C. O., Orkin A. M., Sawyer K. N., Donnino M. W. Part 10: special circumstances of resuscitation: 2015 American Heart Association Guidelines Update for CardiopulmonaryResuscitation and Emergency Cardiovascular Care. Circulation, 2015, vol. 41, no. 2, pp.501-518.Wiener R. S., Ouellette D. R., Diamond E., Fan V. S., Maurer J. R., Mularski R. A., Peters J. I., Halpern S. D. An official American Thoracic Society/American College of Chest Physicians policy statement: the Choosing Wisely top five list in adult pulmonary medicine. Chest, 2014, vol. 145, no. 6, pp. 1383-1391.Wiener R. S., Ouellette D. R., Diamond E., Fan V. S., Maurer J. R., Mularski R. A., Peters J. I., Halpern S. D. An official American Thoracic Society/American College of Chest Physicians policy statement: the Choosing Wisely top five list in adult pulmonary medicine. Chest, 2014, vol. 145, no. 6, pp. 1383-1391.Harjola V. P. Mebazaa A., Celutkiene J., Bettex D., Bueno H., Chioncel O., Crespo-Leiro M.G., Falk V., Filippatos G., Gibbs S., Leite-Moreira A., Lassus J., Masip J., Mueller C., Mullens W., Naeije R. [et al.] Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology. Eur J Heart Faii, 2016, vol. 18, no. 3, pp. 226-241.Harjola V. P. Mebazaa A., Celutkiene J., Bettex D., Bueno H., Chioncel O., Crespo-Leiro M.G., Falk V., Filippatos G., Gibbs S., Leite-Moreira A., Lassus J., Masip J., Mueller C., Mullens W., Naeije R. [et al.] Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology. Eur J Heart Faii, 2016, vol. 18, no. 3, pp. 226-241.Mean M. Tritschler T., Limacher A., Breault S., Rodondi N., Aujesky D., Qanadli S. D. Association between computed tomography obstruction index and mortality in elderly patients with acute pulmonary embolism. PLoSONE, 2017, vol. 12, no. 6, pp. e0179224.Mean M. Tritschler T., Limacher A., Breault S., Rodondi N., Aujesky D., Qanadli S. D. Association between computed tomography obstruction index and mortality in elderly patients with acute pulmonary embolism. PLoSONE, 2017, vol. 12, no. 6, pp. e0179224.Daley M. J., Murthy M. S., Peterson E. J. Bleeding risk with systemic thrombolytic therapy for pulmonary embolism: scope of the problem. Ther Adv Drug Saf, 2015, vol. 2, pp. 57-66.Daley M. J., Murthy M. S., Peterson E. J. Bleeding risk with systemic thrombolytic therapy for pulmonary embolism: scope of the problem. Ther Adv Drug Saf, 2015, vol. 2, pp. 57-66.Jaber W. A., Fong P. P., Weisz G., Lattouf O., Jenkins J., Rosenfield K., Rab T., Ramee S. Acute Pulmonary Embolism: With an Emphasis on an Interventional Approach. J Am Coll Cardiol, 2016, vol. 67, no. 8, pp. 991-1002.Jaber W. A., Fong P. P., Weisz G., Lattouf O., Jenkins J., Rosenfield K., Rab T., Ramee S. Acute Pulmonary Embolism: With an Emphasis on an Interventional Approach. J Am Coll Cardiol, 2016, vol. 67, no. 8, pp. 991-1002.De Gregorio M. A., Guirola J. A., Lahuerta C., Serrano C., Figueredo A. L., Kuo W. T. Interventional radiology treatment for pulmonary embolism. World J Radiol, 2017, vol. 28, no. 9, pp. 295-303.De Gregorio M. A., Guirola J. A., Lahuerta C., Serrano C., Figueredo A. L., Kuo W. T. Interventional radiology treatment for pulmonary embolism. World J Radiol, 2017, vol. 28, no. 9, pp. 295-303.Lumsden, A.B., Suarez E. Interventional therapy for pulmonary embolism. Methodist Debakey Cardiovasc J, 2016, vol. 12, no. 4, pp. 219-224.Lumsden, A.B., Suarez E. Interventional therapy for pulmonary embolism. Methodist Debakey Cardiovasc J, 2016, vol. 12, no. 4, pp. 219-224.Chung, J. Richard J., Owen T. Using inferior vena cava filters to prevent pulmonary embolism. Can Fam Physician, 2008, vol. 54, pp. 49-55.Chung, J. Richard J., Owen T. Using inferior vena cava filters to prevent pulmonary embolism. Can Fam Physician, 2008, vol. 54, pp. 49-55.Kuyumcu, G., Walker G. Inferior vena cava filter retrievals, standard and novel techniques. CardiovascDiagn Ther, 2016, vol. 6, no. 6, pp. 642-650.Kuyumcu, G., Walker G. Inferior vena cava filter retrievals, standard and novel techniques. CardiovascDiagn Ther, 2016, vol. 6, no. 6, pp. 642-650.Streiff, M. B. Vena caval filters: a comprehensive review. Blood, 2000, vol. 95, no. 15, pp. 3669-3677.Streiff, M. B. Vena caval filters: a comprehensive review. Blood, 2000, vol. 95, no. 15, pp. 3669-3677.

The authors declare that there are no conflicts of interest present.