Yu Yanxia, Zhai Zhenguo, Yang Yuanhua, Xie Wanmu, Wang Chen
Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China.
Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China.
Clin Respir J. 2017 May;11(3):383-390. doi: 10.1111/crj.12332. Epub 2015 Jul 24.
Cardiac arrest caused by massive pulmonary embolism (PE) is highly refractory to conventional resuscitation. Thrombolytic therapy has been considered to be an effective way to massive PE.
We reported a case of successful thrombolytic therapy of post-operative massive PE after 90-min cardiopulmonary resuscitation (CPR) and reviewed the relevant literature.
We presented the case of a 48-year-old woman with surgery of varicosis of great saphenous vein who suffered from a massive PE with circulatory arrest refractory to 90 min of aggressive CPR. Thrombolysis was given only as a single dose of 50 mg of recombinant tissue plasminogen activator. Rapid haemodynamic and clinical improvement followed the bolus dose. The patient was discharged later without neurological or other sequelae. An extensive literature search of the PubMed database only identified 11 cases of massive PE with cardiac arrest during the perioperative period with a survival rate was 88.9%. The time period of CPR before thrombolysis or anti-coagulation was 15-90 min.
Thrombolytic therapy is useful to achieve the return of spontaneous circulation in the resuscitation of patients with cardiac arrest secondary to massive PE during the perioperative period, even in the prolong resuscitation.
大面积肺栓塞（PE）所致心脏骤停对传统复苏治疗具有高度难治性。溶栓治疗被认为是治疗大面积PE的有效方法。
我们报告了1例在进行90分钟心肺复苏（CPR）后成功进行术后大面积PE溶栓治疗的病例，并复习相关文献。
我们介绍了1例48岁接受大隐静脉曲张手术的女性患者，该患者发生大面积PE并伴有循环骤停，对90分钟积极的CPR治疗无效。仅给予单剂量50mg重组组织型纤溶酶原激活剂进行溶栓治疗。推注剂量后血流动力学和临床症状迅速改善。患者随后出院，无神经或其他后遗症。对PubMed数据库进行广泛文献检索，仅发现11例围手术期发生心脏骤停的大面积PE病例，生存率为88.9%。溶栓或抗凝治疗前CPR的时间为15 - 90分钟。
溶栓治疗有助于在围手术期继发于大面积PE的心脏骤停患者复苏过程中实现自主循环恢复，即使是在长时间复苏的情况下。
