Böttiger B W, Reim S M, Diezel G
Klinik für Anaesthesiologie, Universität Heidelberg.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1991 Feb;26(1):29-36. doi: 10.1055/s-2007-1000533.
Experience has shown that the bolus injection of streptokinase during resuscitation in case of fulminant pulmonary embolism considerably improves the prognosis. In the case presented here a 64-year old female patient with a fulminant pulmonary embolism was injected with 2 x 1,000,000 I.U. urokinase after 20 minutes of unsuccessful cardiopulmonary resuscitation. Ten minutes after the second injection the circulation could be stabilised by drugs only. The patient survived without any lasting damage. The mechanism of fibrinolysis during resuscitation is discussed. It is also possible to check the diagnosis during resuscitation using echocardiography or angiography. However, treatment must usually start immediately only on clinical diagnosis. Resuscitation in the case of a pulmonary embolism can even be successful after much longer than one hour. Contra-indications must be ignored in such cases. Side effects, which are usually haemorrhages, can as a rule be treated. In our opinion urokinase should be given by preference in the bolus injection during resuscitation. The exception to this is the primary operation during resuscitation. Pulmonary embolectomy is also possible after unsuccessful fibrinolysis.
经验表明，在暴发性肺栓塞复苏过程中推注链激酶可显著改善预后。在此所呈现的病例中，一名64岁患有暴发性肺栓塞的女性患者在心肺复苏20分钟未成功后，注射了2×1,000,000国际单位的尿激酶。第二次注射十分钟后，仅通过药物就能稳定循环。患者存活且无任何持久性损伤。文中讨论了复苏过程中的纤溶机制。在复苏过程中也可使用超声心动图或血管造影来核实诊断。然而，通常必须仅依据临床诊断立即开始治疗。肺栓塞的复苏即便在超过一小时后仍可能成功。在此类情况下必须忽略禁忌证。副作用通常为出血，一般可进行治疗。我们认为在复苏过程中推注时应优先给予尿激酶。复苏期间的初次手术除外。在纤溶治疗失败后也可行肺动脉栓子切除术。
