Department of Medicine, University Health Network and Sinai Health System, University of Toronto, 585 University Avenue, 7th Floor, Room 739, Toronto, Ontario M5G 2N2, Canada.
Ottawa Blood Disease Centre, The Ottawa Hospital, Ottawa, Canada.
Crit Care Clin. 2020 Jul;36(3):465-480. doi: 10.1016/j.ccc.2020.02.004.
Acute pulmonary embolism (PE) is associated with high in-hospital morbidity and mortality, both via cardiorespiratory decompensation and the bleeding complications of treatment. Thrombolytic therapy can be life-saving in those with high-risk PE, but requires careful patient selection. Patients with PE and systemic arterial hypotension ("massive PE") should receive thrombolytic therapy unless severe contraindications are present. Patients with PE and right ventricular dysfunction/injury, but without hypotension ("submassive PE"), should be considered for thrombolysis on a case-by-case basis, considering bleeding risk, cardiac biomarkers, echocardiography, and most importantly, clinical status.
急性肺栓塞（PE）与住院期间高发病率和死亡率相关，这既源于心肺代偿失调，也源于治疗相关的出血并发症。对于高危 PE 患者，溶栓治疗可能是救命的，但需要仔细的患者选择。对于存在全身性动脉低血压（“大面积 PE”）的 PE 患者应接受溶栓治疗，除非存在严重禁忌证。对于存在右心功能障碍/损伤但不存在低血压（“次大面积 PE”）的 PE 患者，应根据具体情况考虑溶栓治疗，需要考虑出血风险、心脏生物标志物、超声心动图，最重要的是临床状况。
