Masters R G, Koshal A, Higginson L A, Keon W J
University of Ottawa Heart Institute, Ottawa Civic Hospital, Ontario.
Can J Cardiol. 1988 Oct;4(7):347-51.
Pulmonary embolism remains a frequent and often fatal disorder. For the majority of patients, anticoagulation with heparin followed by warfarin represents the primary mode of treatment. Thrombolytic therapy is recommended for the patient with massive pulmonary embolism that has produced hypotension. Embolectomy is reserved for the patient with post embolic systemic hypotension who has an absolute contraindication to thrombolysis or who deteriorates despite thrombolytic therapy. Following successful embolectomy the surgeon must treat the complications of the surgery and prevent recurrence. Complications include cerebral infarction, pulmonary infarction and endobronchial hemorrhage, right ventricular failure, local or systemic bleeding and venous stasis. A case of successful pulmonary embolectomy with a complicated postoperative course is presented and the pathophysiology and treatment of the complications are discussed.
肺栓塞仍然是一种常见且往往致命的疾病。对于大多数患者来说，先用肝素抗凝，然后使用华法林是主要的治疗方式。对于发生低血压的大面积肺栓塞患者，推荐进行溶栓治疗。栓子切除术适用于有栓塞后系统性低血压且有溶栓绝对禁忌证或尽管进行了溶栓治疗仍病情恶化的患者。成功进行栓子切除术后，外科医生必须处理手术并发症并预防复发。并发症包括脑梗死、肺梗死和支气管内出血、右心室衰竭、局部或全身出血以及静脉淤滞。本文介绍了一例术后病程复杂但成功进行肺栓子切除术的病例，并讨论了并发症的病理生理学和治疗方法。
