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[心肺复苏期间的溶栓治疗——自身临床观察——病例报告]

[Thrombolysis during cardiopulmonary resuscitation--own clinical observations--case report].

作者信息

Czaban Sławomir Lech, Musiuk Tomasz, Siemiatkowski Andrzej

机构信息

Klinika Anestezjologii i Intensywnej Terapii Akademii Medycznej w Białymstoku.

出版信息

Przegl Lek. 2007;64(7-8):538-40.

Abstract

Thrombolytic therapy is contraindicated in the course of cardiopulmonary resuscitation (CPR). If the primary cause of cardiac arrest is myocardial infarction or massive pulmonary embolism, fibrynolysis may be life-saving. We present a case report of a woman admitted to the Intensive Care Unit with cardiac arrest with symptoms suggesting myocardial infarction or pulmonary embolism. After unsuccessful conservative CPR a single dose of 500000 IU streptase was administered. Heart action returned 10 minutes later, nevertheless the patient needed mechanical ventilation and circulatory system stabilization therapy (catecholamines) in doses dependent on haemodynamic parameters. During hospitalization she regained consciousness. She presented no neurological defects and after 5 days was discharged to the Cardiology Department. Electrocardiography and echocardiography done after successful resuscitation was specific to infero-lateral myocardial infarction. Although safety and efficacy of thrombolytic therapy at resuscitation was extensively studied, this procedure is still controversial. Till now, there is no data concerning thrombolytic treatment in such clinical situations, which are based on clinical trials, and such treatment is introduced in dramatic situations, as a last, lifesaving option.

摘要

在心肺复苏(CPR)过程中,溶栓治疗是禁忌的。如果心脏骤停的主要原因是心肌梗死或大面积肺栓塞,纤维蛋白溶解可能挽救生命。我们报告一例女性患者,因心脏骤停入住重症监护病房,症状提示心肌梗死或肺栓塞。在保守的心肺复苏失败后,给予了500000国际单位的链激酶单剂量治疗。10分钟后心脏恢复跳动,然而患者需要机械通气和循环系统稳定治疗(儿茶酚胺),剂量根据血流动力学参数而定。住院期间她恢复了意识。她没有出现神经功能缺损,5天后出院转至心内科。成功复苏后进行的心电图和超声心动图检查显示为下壁-侧壁心肌梗死。尽管对复苏时溶栓治疗的安全性和有效性进行了广泛研究,但该程序仍存在争议。到目前为止,尚无基于临床试验的关于此类临床情况溶栓治疗的数据,且这种治疗是在危急情况下作为最后的救命选择引入的。

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