Duroux P, Simonneau G, Petitpretz P, Herve P
Intensive Care Med. 1984;10(2):99-102. doi: 10.1007/BF00297566.
Many therapeutic aspects of venous thromboembolism continue to generate controversy so that the general therapeutic guidelines given below are only indicative. The first step is the diagnosis of venous thromboembolism; this is done in the vast majority of patients by visualization of blood clots using either pulmonary angiography or phlebography. The second step is to arrest the thrombotic process; the best means of doing this is to administer IV heparin. In the case of contra-indication or documented inefficacy of heparin therapy, the only therapeutic solution is to interrupt the inferior vena cava either with a clip, an umbrella or a filter. The blood clot lysis, which represents the third step, is effected by the natural fibrinolytic system. Thrombolytics , administered as a bolus of urokinase (15000 CTA U/kg), are indicated in cases of life-threatening pulmonary emboli, i.e. those with a pulmonary vascular obstruction of more than 50% and with hypotension, shock, or acute right ventricular failure. The use of thrombolytics is more questionable when they are administered to improve the quality of vascular patency. The only indication for pulmonary embolectomy is a contra-indication or inefficacy of thrombolytics . Due to the diagnostic and therapeutic difficulties, the first and most important part of the treatment of pulmonary emboli must be the broad application of prophylaxis treatment in patients with a high risk of venous thromboembolism.
静脉血栓栓塞症的许多治疗方面仍存在争议，因此以下给出的一般治疗指南仅具有指示性。第一步是诊断静脉血栓栓塞症；绝大多数患者通过使用肺血管造影或静脉造影来观察血凝块来完成这一步。第二步是阻止血栓形成过程；最好的方法是静脉注射肝素。在肝素治疗存在禁忌证或已证明无效的情况下，唯一的治疗解决方案是用夹子、伞或过滤器中断下腔静脉。血凝块溶解是第三步，由天然纤维蛋白溶解系统完成。在危及生命的肺栓塞病例中，即那些肺血管阻塞超过50%且伴有低血压、休克或急性右心室衰竭的病例，以尿激酶大剂量（15000CTA U/kg）给药的溶栓剂是适用的。当使用溶栓剂来改善血管通畅质量时，其使用更值得怀疑。肺栓子切除术的唯一指征是溶栓剂存在禁忌证或无效。由于诊断和治疗困难，肺栓塞治疗的首要且最重要的部分必须是在静脉血栓栓塞症高危患者中广泛应用预防性治疗。
