Fasullo Sergio, Maringhini Giorgio, Terrazzino Gabriella, Ganci Filippo, Paterna Salvatore, Di Pasquale Pietro
Division of Cardiology, "Paolo Borsellino" G,F, Ingrassia Hospital, Palermo, Italy.
Int J Emerg Med. 2011 Oct 31;4:69. doi: 10.1186/1865-1380-4-69.
Mortality from pulmonary embolism (PE) in pregnancy might be related to challenges in targeting the right population for prevention. Such targeting could help ensure that the correct diagnosis is suspected and adequately investigated, and allow the initiation of the timely and best possible treatment of this disease. In the literature to date only 18 case reports of thrombolysis in pregnant women with PE have been reported, and showed beneficial effects for both mother and fetus in terms of mortality and complications with acceptable bleeding risks. We present here the case of a pregnant patient with massive PE who underwent successful thrombolysis. A 26-year-old pregnant (at 24 weeks) woman was admitted 4 h after onset of sudden acute dyspnea and chest pain. An immediate electrocardiogram showed a typical S1-Q3-T3 pattern. The echocardiogram showed a distended right ventricle with free-wall hypokinesia and displacement of the interventricular septum toward the left ventricle. Thrombolysis with recombinant tissue plasminogen activator (alteplase 10 mg bolus, then 90 mg over 2 h) was administered. Pelvic examination and ultrasound showed regular fetal heart beat, and regular placental and liquid presence. No problems developed for the mother or fetus in the subsequent days or at discharge. In conclusion, in pregnant patients with life-threatening massive PE, thrombolytic therapy can be administered, and the use of echocardiographic, laboratory, and clinical data can be useful tools to achieve a rapid diagnosis and make a therapeutic decision, but additional studies need to be performed to further define its use.
妊娠期肺栓塞（PE）导致的死亡可能与针对正确人群进行预防方面的挑战有关。这种针对性有助于确保怀疑正确的诊断并进行充分调查，并能及时启动对该疾病的最佳治疗。在迄今为止的文献中，仅报道了18例妊娠期PE患者溶栓的病例报告，这些报告显示，在死亡率和并发症方面，对母亲和胎儿均有益，且出血风险可接受。我们在此介绍一例成功接受溶栓治疗的妊娠期大面积PE患者的病例。一名26岁的孕妇（孕24周）在突发急性呼吸困难和胸痛4小时后入院。即刻心电图显示典型的S1-Q3-T3图形。超声心动图显示右心室扩张，游离壁运动减弱，室间隔向左心室移位。给予重组组织型纤溶酶原激活剂（阿替普酶10mg静脉推注，然后在2小时内给予90mg）进行溶栓治疗。盆腔检查和超声显示胎儿心跳正常，胎盘和羊水情况正常。在随后的几天或出院时，母亲和胎儿均未出现问题。总之，对于妊娠期危及生命的大面积PE患者，可进行溶栓治疗，超声心动图、实验室检查和临床数据的应用有助于快速诊断并做出治疗决策，但需要进行更多研究以进一步明确其应用。
