Ruberti U, Odero A, Giordanengo F, Miani S
Minerva Med. 1978 May 26;69(26):1785-95.
The frequency of pulmonary embolization seems to be increasing. Venostasis, intimal damage and hypercoagulability of blood are the more recognized causes of pulmonary thromboembolism. It is especially threatening to the elderly, obese, immobilized (for an accident or an operation) patients. Pulmonary isotopic scans or angiograms are most often relied upon to establish the diagnosis. A properly performed pulmonary angiography is necessary to establish or refute the diagnosis in almost every case. With the exception of the patients suddenly dying for a massive pulmonary embolism, the period of time between onset of symptoms and death is usually adequate for substantiating a diagnosis and promptly beginning a fit anticoagulation therapy using continuous intravenous heparin or fibrinolytic agents infusion. Although it is not proper to separate surgical and medical treatment of thromboembolism, the Authors, on the ground of their experience on 5 patients affected by massive pulmonary embolism, in 3 of whom was performed a successful embolectomy, think that heparin anticoagulation treatment is at any rate to apply for treating pulmonary embolism, but in patients in whom the shock is unresponsive to vasopressors or in whom anticoagulation therapy is controindicated, the surgical removal of pulmonary emboly, with the support of a pump oxygenator, is the treatment of choice for the acute massive pulmonary thromboembolism.
肺栓塞的发生率似乎在上升。静脉淤滞、内膜损伤和血液高凝状态是肺血栓栓塞更常见的病因。这对老年人、肥胖者、因事故或手术而行动不便的患者尤其具有威胁性。肺同位素扫描或血管造影术常常被用来进行诊断。在几乎所有病例中，进行恰当的肺血管造影对于确诊或排除诊断都是必要的。除了因大面积肺栓塞突然死亡的患者外，从症状出现到死亡的这段时间通常足以证实诊断并迅速开始适当的抗凝治疗，即持续静脉输注肝素或溶栓剂。虽然将血栓栓塞的手术治疗和内科治疗区分开来并不恰当，但作者基于对5例大面积肺栓塞患者的经验（其中3例成功进行了栓子切除术）认为，无论如何肝素抗凝治疗都适用于治疗肺栓塞，但对于休克对血管加压药无反应或抗凝治疗禁忌的患者，在体外循环氧合器的支持下手术清除肺栓子是急性大面积肺血栓栓塞的首选治疗方法。
