Manthey J, Fröhlich G, Mautner J P, Munderloh K H, Zimmermann R
Abt. Innere Medizin/Kardiologie, Kreiskrankenhaus am Plattenwald, Bad Friedrichshall.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1994 Nov;29(7):446-9. doi: 10.1055/s-2007-996783.
A 77-year-old female patient presenting with recurrent pulmonary embolism and shock had a severe craniocerebral trauma after collapsing at home 2 days before admission. Since systemic thrombolytic therapy appeared hazardous in this patient, percutaneous fragmentation and distal dispersion of the proximal pulmonary emboli was performed using a pigtail catheter. This procedure improved cardiac output immediately by 15%, whereas the mean pulmonary artery pressure dropped only slightly from 48 to 46 mmHg. Thereafter, a streptokinase infusion of 100,000 IU during 1 h was instituted through the pigtail catheter into the pulmonary artery. 12 hours after the treatment was started, cardiac output was raised by 70% and mean pulmonary artery pressure was decreased from 48 to 25 mmHg. 14 days after admission, control ventilation-perfusion scan showed a markedly improved pulmonary perfusion, and right heart catheterization revealed normal right heart pressures. The patient recovered rapidly and there was no evidence of recurrent pulmonary embolism 18 months later. This report demonstrates that a percutaneous catheter fragmentation of proximal pulmonary emboli combined with local intermediate-dose infusion of streptokinase may be a helpful therapeutic option in patients with massive pulmonary embolism in whom systemic thrombolytic therapy is contraindicated.
一名77岁女性患者，反复出现肺栓塞并伴有休克，入院前2天在家中晕倒后发生严重颅脑外伤。由于全身溶栓治疗对该患者似乎具有危险性，因此使用猪尾导管对近端肺栓塞进行经皮破碎及远端分散处理。此操作立即使心输出量提高了15%，而平均肺动脉压仅从48 mmHg略微降至46 mmHg。此后，通过猪尾导管向肺动脉内注入100,000 IU链激酶，持续1小时。治疗开始12小时后，心输出量提高了70%，平均肺动脉压从48 mmHg降至25 mmHg。入院14天后，对照通气-灌注扫描显示肺灌注明显改善，右心导管检查显示右心压力正常。患者恢复迅速，18个月后无复发性肺栓塞迹象。本报告表明，对于全身溶栓治疗禁忌的大面积肺栓塞患者，经皮导管破碎近端肺栓塞并联合局部中等剂量注入链激酶可能是一种有效的治疗选择。
