Division of Cardiac Surgery, Massachusetts General Hospital, Cox 6, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: https://twitter.com/@criticalecho.
Cardiac Intensive Care Unit, Department of Cardiology, Heart Center Intensive Care Unit, Massachusetts General Hospital, Blake 254, 55 Fruit Street, Boston, MA 02114, USA.
Surg Clin North Am. 2022 Jun;102(3):429-447. doi: 10.1016/j.suc.2022.02.004. Epub 2022 Apr 21.
Pulmonary embolism (PE) is the third leading cause of cardiovascular mortality in the United States. Unfortunately, significant gaps exist in outcome data around many interventional therapies, a fact that is reflected in the low strength of management recommendations found in consensus major society guidelines. In addition to careful risk stratification, therapeutic anticoagulation generally should be an early part of PE management in all cases. For patients presenting with acute high-risk PE or intermediate-risk PE with higher risk features, consideration should be given to systemic thrombolysis after careful evaluation for potential bleeding complications. In patients with contraindications to systemic thrombolysis, failure of this therapy, or significant ongoing cardiopulmonary distress, consideration should be given to interventional therapies like catheter-directed lysis, catheter-directed embolectomy, surgical embolectomy, and mechanical circulatory support. Until more robust comparative outcome data are put forward, pulmonary embolism response teams (PERT) should be considered for multi-disciplinary patient evaluation and management.
肺栓塞（PE）是美国心血管死亡的第三大主要原因。不幸的是，许多介入治疗的结果数据存在显著差距，这一事实反映在共识主要学会指南中发现的管理建议的低强度上。除了仔细的风险分层外，在所有情况下，治疗性抗凝通常应该是 PE 管理的早期部分。对于出现急性高危 PE 或具有更高风险特征的中危 PE 的患者，在仔细评估潜在出血并发症后，应考虑全身溶栓治疗。对于有全身溶栓治疗禁忌、治疗失败或持续存在心肺窘迫的患者，应考虑介入治疗，如导管溶栓、导管取栓、手术取栓和机械循环支持。在提出更有力的比较结果数据之前，应考虑肺栓塞反应小组（PERT）对多学科患者评估和管理。
