Okubo S, Yoshioka T, Nakanishi N, Kunieda T, Yutani C, Shimouchi A
Division of Cardiology, National Cardiovascular Center.
Kokyu To Junkan. 1990 Apr;38(4):375-81.
Acute fatal pulmonary embolism is one cause of sudden death which should be guarded against. It is the most often missed diagnosis in sudden death cases within the hospital. Clinical pictures of 10 patients with acute fatal pulmonary embolism proved by autopsy were examined to elucidate the problems of diagnosis, and to look for an effective treatment, and a method of prevention. Common risk factors were old age and immobility due to stroke or postoperative state. Common past histories were hypertension, diabetes mellitus, obesity, atrial fibrillation and hyperlipidemia. Electrocardiogram and echocardiogram showed that in these patients there was definite evidence of acute right ventricular overload. High doses of intravenous urokinase should be given whenever acute cardiovascular collapse develops in such high risk patients. Emergent pulmonary angiogram and pulmonary embolectomy could be life-saving in patients with acute massive pulmonary embolism. Prevention is, however, the best treatment. In addition to anticoagulation medication, frequent change of body position and early mobilization are important precautions to prevent fatal pulmonary embolism developing in such patients.
急性致命性肺栓塞是一种应予以防范的猝死原因。它是医院内猝死病例中最常被漏诊的疾病。对经尸检证实的10例急性致命性肺栓塞患者的临床资料进行分析，以阐明诊断问题，寻找有效的治疗方法及预防措施。常见的危险因素为高龄以及因中风或术后状态导致的活动受限。常见的既往病史有高血压、糖尿病、肥胖症、心房颤动和高脂血症。心电图和超声心动图显示，这些患者有明确的急性右心室负荷过重的证据。对于此类高危患者，一旦发生急性心血管衰竭，应给予大剂量静脉注射尿激酶。对于急性大面积肺栓塞患者，紧急肺血管造影和肺栓子切除术可能挽救生命。然而，预防是最佳治疗方法。除抗凝药物治疗外，频繁变换体位和早期活动是预防此类患者发生致命性肺栓塞的重要预防措施。
