Lee Licheng, Kavinsky Clifford J, Spies Christian
The University of Hawaii, Department of Medicine, Honolulu, HI, USA.
Expert Rev Cardiovasc Ther. 2010 Jun;8(6):863-73. doi: 10.1586/erc.10.52.
Massive or high-risk pulmonary embolism (PE), defined as PE in the setting of (transient) arterial hypotension or frank cardiogenic shock, is associated with a poor prognosis. Fibrinolytic therapy is the mainstay of therapy, although data to support its effectiveness are limited. Although rarely performed, an alternate, accepted treatment strategy is surgical embolectomy. Contraindications to fibrinolytics are common in the setting of high-risk PE, and surgical embolectomy is frequently not performed owing to excessively high surgical risk. Under those circumstances, percutaneous, catheter-based thrombectomy or thrombus fragmentation is a reasonable alternative. In this article, we summarize the data available to date, evaluating the three different treatment options. We also attempt to synthesize a treatment algorithm to guide the practitioner in the treatment of patients with high-risk or massive PE.
大面积或高危肺栓塞（PE）定义为伴有（短暂性）动脉低血压或明显心源性休克的PE，其预后较差。纤维蛋白溶解疗法是主要的治疗方法，尽管支持其有效性的数据有限。虽然很少实施，但另一种被认可的治疗策略是外科血栓切除术。在高危PE患者中，纤维蛋白溶解剂的禁忌证很常见，而且由于手术风险过高，外科血栓切除术常常无法进行。在这种情况下，经皮导管血栓切除术或血栓碎裂术是一种合理的替代方法。在本文中，我们总结了迄今为止可用的数据，评估了这三种不同的治疗选择。我们还试图综合出一种治疗算法，以指导医生治疗高危或大面积PE患者。
