Mercer Rachel M, Bowen Jordan S T, Armstrong Richard J
Royal Berkshire Hospital, Reading, UK.
BMJ Case Rep. 2013 Dec 10;2013:bcr2013009724. doi: 10.1136/bcr-2013-009724.
Acute massive pulmonary embolism (PE) can be fatal; however, timely thrombolytic therapy can be life saving. Guidelines advocate the use of thrombolysis for massive PE in patients with an acceptable bleeding-risk profile. Nonetheless, estimating what constitutes an acceptable bleeding risk in those with life-threatening PE is a clinical challenge, and even contraindications considered 'absolute' may present lesser risk than leaving PE untreated. We discuss the case of a 77-year-old man who received thrombolysis for a massive PE 4 weeks following admission with a significant intracerebral bleed. There was rapid resolution of hypotension and hypoxia and he survived to be discharged home. This case is used to illustrate that no potential therapy should be discounted in patients faced with acute life-threatening PE. Decisions to thrombolyse patients with traditional contraindications-even those considered absolute-must be taken by clinicians able to weigh relative risks.
急性大面积肺栓塞（PE）可能致命；然而，及时的溶栓治疗可挽救生命。指南提倡对具有可接受出血风险特征的大面积PE患者使用溶栓治疗。尽管如此，评估那些危及生命的PE患者中何为可接受的出血风险是一项临床挑战，而且即使被视为“绝对”的禁忌症，其风险可能也低于不治疗PE的风险。我们讨论了一例77岁男性患者的病例，该患者在因严重脑出血入院4周后接受了大面积PE的溶栓治疗。低血压和低氧血症迅速缓解，他存活并出院回家。该病例用于说明，面对急性危及生命的PE患者，不应忽视任何潜在治疗方法。对于有传统禁忌症（甚至那些被视为绝对禁忌症）的患者进行溶栓治疗的决策，必须由能够权衡相对风险的临床医生做出。
