Jawad Muhammad, Apsey Caroline
Acute Internal Medicine, Surrey and Sussex Healthcare National Health Service Trust, Redhill, GBR.
Internal Medicine, Lewisham and Greenwich National Health Service Trust, London, GBR.
Cureus. 2020 Nov 6;12(11):e11359. doi: 10.7759/cureus.11359.
Aims Current British Thoracic Society (BTS) guidelines only recommend thrombolysis of pulmonary embolism (PE) in patients who are haemodynamically compromised. Newer evidence suggests a mortality benefit for the thrombolysis of sub-massive PE with right ventricular strain. We wanted to assess the outcome and safety of thrombolysis in patients with sub-massive PE in a DGH. Methods The notes for patients with sub-massive PE and thrombolysis from a two-year period were reviewed. Evidence of right ventricular strain and myocardial necrosis based on bedside echocardiography, computed tomography (CT) scan and troponin T were indications for thrombolysis. Results A total of 22 patients had thrombolysis of PE in the study period (56±14 years). Fourteen patients were classified as sub-massive PE (55±15 years). Out of eight patients who had thrombolysis of massive PE (58±14 years), three were initially classified as sub-massive PE but deteriorated within the next 48 hours and became haemodynamically unstable. In all patients, the diagnosis was confirmed with a CT pulmonary angiography (CTPA). Mean troponin was 82 in the sub-massive PE group and 102 in the massive PE group. The clinical condition and haemodynamic of patients improved rapidly within a few hours after thrombolysis. Post-thrombolysis echocardiography was performed, 17 patients had normal right ventricles with normal pulmonary arterial pressures. Conclusion Thrombolysis of sub-massive pulmonary embolism is feasible in a district general hospital and seems to be a safe procedure, particularly in younger patients. It results in rapid improvement in the clinical condition of patients with a small incidence of bleeding complications.
当前英国胸科学会（BTS）指南仅推荐对血流动力学不稳定的肺栓塞（PE）患者进行溶栓治疗。最新证据表明，对伴有右心室劳损的次大面积PE进行溶栓可降低死亡率。我们旨在评估在一家区综合医院（DGH）中，次大面积PE患者接受溶栓治疗的疗效和安全性。
回顾了两年内次大面积PE患者及接受溶栓治疗患者的病历。基于床旁超声心动图、计算机断层扫描（CT）和肌钙蛋白T的右心室劳损及心肌坏死证据是溶栓的指征。
在研究期间，共有22例患者接受了PE溶栓治疗（年龄56±14岁）。其中14例被归类为次大面积PE（年龄55±15岁）。在8例接受大面积PE溶栓治疗的患者中（年龄58±14岁），有3例最初被归类为次大面积PE，但在接下来的48小时内病情恶化，血流动力学变得不稳定。所有患者均通过CT肺动脉造影（CTPA）确诊。次大面积PE组的平均肌钙蛋白水平为82，大面积PE组为102。溶栓治疗后数小时内，患者的临床状况和血流动力学迅速改善。溶栓后进行了超声心动图检查，17例患者的右心室正常，肺动脉压正常。
在区综合医院对次大面积肺栓塞进行溶栓治疗是可行的，且似乎是一种安全的方法，尤其是在年轻患者中。它能使患者的临床状况迅速改善，出血并发症发生率较低。
