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导管溶栓治疗及复苏措施在一名心脏骤停伴大面积肺栓塞患者中的疗效:病例报告

Outcomes of Catheter-Delivered Thrombolytic Therapy and Resuscitative Measures in a Cardiac Arrest Patient With Massive Pulmonary Embolism: A Case Report.

作者信息

Lasfer Chafika, Yaslam Manal, Sohail Zebunnisa

机构信息

Emergency Medicine, Fakeeh University Hospital, Dubai, ARE.

Emergency Medicine, Rashid Hospital, Dubai, ARE.

出版信息

Cureus. 2022 Aug 31;14(8):e28654. doi: 10.7759/cureus.28654. eCollection 2022 Aug.

DOI:10.7759/cureus.28654
PMID:36196327
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9525920/
Abstract

Acute massive pulmonary embolism is the most critical presentation of venous thromboembolism that needs early detection and management for a better outcome. We present the case of a 42-year-old female who presented to the emergency department (ED) complaining of acute dyspnea and descended into cardiac arrest. Working through the advanced cardiac life support guidelines and appropriate resuscitative measures, having high clinical suspicion supported by bedside ultrasound findings, massive pulmonary embolism was the most likely diagnosis, and so the patient was treated with thrombolytic therapy delivered via a central venous catheter. Return of spontaneous circulation was achieved, and consequently, she made a complete recovery with no adverse neurological or hemodynamic sequelae. The aim of presenting this topic is to review the literature available on approaches to thrombolytic doses in life-threatening cases of massive pulmonary embolism and to add to an already ongoing discussion about the effects and outcomes of various dosing regimens. The above facts will lead us to conclude that any discussion seeks to remind us of the primary management principle. All physicians should bear this in mind while managing any case ("," which is a Latin phrase that means "first, do no harm"); it helps to fuel ideologies to seek best practice interventions that ensure the best outcome for pulmonary embolism patients. And such experiences are worth sharing with the world.

摘要

急性大面积肺栓塞是静脉血栓栓塞最危急的表现形式,需要早期检测和处理以获得更好的预后。我们报告一例42岁女性病例,该患者因急性呼吸困难就诊于急诊科,随后陷入心脏骤停。按照高级心脏生命支持指南并采取适当的复苏措施,结合床边超声检查结果高度怀疑为大面积肺栓塞,遂对患者进行了经中心静脉导管溶栓治疗。患者恢复自主循环,最终完全康复,未出现不良神经或血流动力学后遗症。介绍本病例的目的是回顾有关危及生命的大面积肺栓塞病例溶栓剂量方法的现有文献,并加入正在进行的关于各种给药方案的效果和结果的讨论。上述事实将使我们得出结论,任何讨论都旨在提醒我们首要的管理原则。所有医生在处理任何病例时都应牢记这一点(“primum non nocere”,这是一句拉丁语,意为“首先,不伤害”);它有助于推动寻求最佳实践干预措施的理念,以确保肺栓塞患者获得最佳预后。并且这样的经验值得与全世界分享。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/475d/9525920/cbba67542e46/cureus-0014-00000028654-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/475d/9525920/9f4b8084b3fd/cureus-0014-00000028654-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/475d/9525920/8facb23b5aa5/cureus-0014-00000028654-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/475d/9525920/8ba23e59863e/cureus-0014-00000028654-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/475d/9525920/8d357396e826/cureus-0014-00000028654-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/475d/9525920/cbba67542e46/cureus-0014-00000028654-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/475d/9525920/9f4b8084b3fd/cureus-0014-00000028654-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/475d/9525920/8facb23b5aa5/cureus-0014-00000028654-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/475d/9525920/8ba23e59863e/cureus-0014-00000028654-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/475d/9525920/8d357396e826/cureus-0014-00000028654-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/475d/9525920/cbba67542e46/cureus-0014-00000028654-i05.jpg

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2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS).2019年欧洲心脏病学会(ESC)与欧洲呼吸学会(ERS)合作制定的急性肺栓塞诊断和管理指南。
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