Salzberg A, Ritz R
Abteilung Intensivmedizin, Kantonsspital Basel.
Schweiz Med Wochenschr. 1987 Aug 22;117(34):1256-9.
Over one fifth of patients hospitalized for massive pulmonary embolism die within the first few hours. The threatening load on the right ventricle can be reduced by early detection of embolism and immediate start to treatment. 53 patients treated for pulmonary embolism in our intensive care unit from 1982-1984 were divided into groups of 34 patients with massive embolism (occlusion 50% and/or circulatory shock) and 16 patients with small embolism. In 3 additional patients the embolism was detected only at autopsy. Patient's history and first clinical workup, together with special investigations and hemodynamics, allowed differentiation between massive and small embolism. Regarding treatment, patients with pulmonary embolism and circulatory shock were immediately embolectomized surgically. The other patients with massive embolism were treated by early fibrinolysis, with strict attention to any contraindications. These fibrinolyzed patients had fewer complications during the subsequent hospital course. A total of 8 patients with massive embolism and 2 patients with small embolism died during the same hospital stay. Where history and clinical findings prompt suspicion of massive pulmonary embolism a rather aggressive diagnostic procedure is indicated, since rapid reopening of the pulmonary circuit, to reduce the load on the right ventricle, may be life-saving.
超过五分之一因大面积肺栓塞住院的患者在最初几小时内死亡。通过早期发现栓塞并立即开始治疗，可以减轻右心室的负荷。1982年至1984年在我们重症监护病房接受肺栓塞治疗的53例患者被分为两组，34例为大面积栓塞（阻塞50%和/或循环休克）患者，16例为小面积栓塞患者。另有3例患者仅在尸检时才发现栓塞。患者的病史、首次临床检查，以及特殊检查和血流动力学检查，有助于区分大面积和小面积栓塞。在治疗方面，患有肺栓塞和循环休克的患者立即接受手术取栓。其他大面积栓塞患者接受早期纤溶治疗，并严格注意任何禁忌症。这些接受纤溶治疗的患者在随后的住院过程中并发症较少。共有8例大面积栓塞患者和2例小面积栓塞患者在同一住院期间死亡。当病史和临床检查结果提示怀疑为大面积肺栓塞时，应采取较为积极的诊断程序，因为迅速重新开通肺循环以减轻右心室负荷可能挽救生命。
