Kessler C M
Division of Hematology-Oncology, George Washington University Medical Center, Washington, D.C. 20037.
Lung. 1990;168 Suppl:841-8. doi: 10.1007/BF02718218.
Pulmonary embolism is diagnosed over 100,000 times yearly in the United States and is the recognized primary cause of death in at least 10,000 cases. Thrombolytic therapy has been successful in reducing clot burden substantially; however, clinical data are lacking to indicate that thrombolytic therapy improves mortality rates in patients with pulmonary emboli or that the pharmacologic removal of clot will improve future quality of life. The use of thrombolytic agents has been limited by the potential for producing hemorrhagic complications. This paper discusses the pharmacology of numerous thrombolytic agents and their clinical use in research studies intended to determine the safest and most efficacious regimens. Recombinant t-PA infusions appear quite safe and produce very rapid lyses of pulmonary emboli. Innovative administration regimens of urokinase also appear promising. The availability of extremely safe and efficacious treatment regimens should allow for large epidemiologic studies to be conducted to determine whether thrombolytic therapy will improve the morbidity and mortality of pulmonary embolism.
在美国，每年有超过10万例肺栓塞被诊断出来，并且至少在1万例病例中，它是公认的主要死因。溶栓治疗已成功大幅减轻血栓负荷；然而，缺乏临床数据表明溶栓治疗能提高肺栓塞患者的死亡率，或者血栓的药物清除能改善未来的生活质量。溶栓药物的使用因产生出血并发症的可能性而受到限制。本文讨论了多种溶栓药物的药理学及其在旨在确定最安全、最有效治疗方案的研究中的临床应用。重组组织型纤溶酶原激活剂（t-PA）输注似乎相当安全，能非常迅速地溶解肺栓塞。尿激酶的创新给药方案也似乎很有前景。极其安全有效的治疗方案的出现应能使开展大规模流行病学研究成为可能，以确定溶栓治疗是否会改善肺栓塞的发病率和死亡率。
