Liao Jiyang, Lai Fang, Xie Dongping, Han Yun, Mai Shutao, Weng Yanna, Zhang Yan, Du Jiongdong, Zhou Gengbiao
Postgraduate Student of the Second Clinical College of Guangzhou University of Chinese Medicine.
The Second Affiliated Hospital of Guangzhou University of Chinese Medicine.
Medicine (Baltimore). 2018 Oct;97(43):e12985. doi: 10.1097/MD.0000000000012985.
Thrombolysis in primigravida with hemodynamic instability is controversial, especially treatment with low-dosage recombinant tissue plasminogen activator (rtPA), and related studies are extremely rare. Here, we report the case of a 26-year-old primigravida diagnosed with an acute massive pulmonary embolism (PE) that prompted initiation of thrombolysis with low-dose alteplase.
The patient was admitted to the Emergency Department with chief complaints of a sudden onset of extremely dyspnea, chest tightness, and confusion over a 6-hour period. She was found to have significant dilation of her right ventricle, moderate pulmonary arterial hypotension, as shown by transthoracic echocardiography, and a typical S1-Q3-T3 pattern, as shown by electrocardiogram (ECG).
Acute massive PE in primigravida.
The patient underwent intravenous thrombolysis with a half dose of alteplase.
The fetus lived through this severe event during the mother's stay in the Intensive Care Unit; however, surgical abortion was unexpectedly proposed due to long-term hypoxia and high-risk of relapse and exacerbation and was performed successfully after the agreement of her kin. The patient recovered gradually, and results of her laboratory tests and postsurgical, repeated contrast-enhanced computed tomography had normalized by her 3-month follow-up.
Administration of low-dosage alteplase in primigravida with hemodynamic instability is extremely rare and controversial; however, our case suggests that this treatment strategy is relatively safe and feasible. In addition, nonradiometric examination played a major role in the diagnosis of PE in this patient. Because radiation use is contraindicated during pregnancy, these examinations could be the first choice for pregnant patients with suspected PE.
初产妇血流动力学不稳定时进行溶栓治疗存在争议，尤其是使用低剂量重组组织型纤溶酶原激活剂（rtPA）治疗，相关研究极为罕见。在此，我们报告一例26岁初产妇，诊断为急性大面积肺栓塞（PE），促使我们使用低剂量阿替普酶启动溶栓治疗。
患者因突发极度呼吸困难、胸闷及6小时内意识模糊为主诉入住急诊科。经胸超声心动图显示她右心室明显扩张，中度肺动脉低血压，心电图（ECG）显示典型的S1-Q3-T3模式。
初产妇急性大面积PE。
患者接受了半剂量阿替普酶的静脉溶栓治疗。
胎儿在母亲入住重症监护病房期间度过了这一严重事件；然而，由于长期缺氧及复发和加重的高风险，意外建议进行人工流产，在其亲属同意后手术成功进行。患者逐渐康复，3个月随访时其实验室检查结果及术后重复对比增强计算机断层扫描结果已恢复正常。
初产妇血流动力学不稳定时使用低剂量阿替普酶极为罕见且存在争议；然而，我们的病例表明这种治疗策略相对安全可行。此外，非放射性检查在该患者PE的诊断中起主要作用。由于孕期禁忌使用辐射，这些检查可为疑似PE的孕妇首选。
