Nasraway S A, Kabani N, Lawrence K R
Department of Anesthesia, New England Medical Center, Boston, Massachusetts 02111.
Pharmacotherapy. 1994 Sep-Oct;14(5):616-9.
Life-threatening acute pulmonary embolism (PE) associated with circulatory shock requires effective therapy directed at removing the obstruction to flow in the pulmonary vasculature and improving hemodynamics. Options for treatment are pulmonary embolectomy and thrombolytic therapy. Although safe and effective, thrombolytic therapy is relatively contraindicated within 10 days of major surgery due to the risk of bleeding. Intravenous streptokinase was administered to a man on the third postoperative day for treatment of a massive PE associated with circulatory shock. Within 2 hours of initiating therapy, the patient experienced marked improvement in hemodynamics and tissue perfusion. No bleeding complications were noted. This case demonstrates that intravenous thrombolytics may be administered safely to patients who have recently undergone surgery. It also underscores that the decision to apply the therapy when relatively contraindicated must be made on an individual patient basis and thus ensure that potentially life-saving therapy is not withheld from those who require it most.
与循环性休克相关的危及生命的急性肺栓塞（PE）需要有效的治疗，旨在消除肺血管系统血流的阻塞并改善血流动力学。治疗选择包括肺栓子切除术和溶栓治疗。尽管溶栓治疗安全有效，但由于出血风险，在大手术后10天内相对禁忌使用。一名男性在术后第三天接受静脉注射链激酶治疗与循环性休克相关的大面积PE。在开始治疗后2小时内，患者的血流动力学和组织灌注有明显改善。未发现出血并发症。该病例表明，静脉溶栓可安全地应用于近期接受手术的患者。它还强调，在相对禁忌的情况下应用该治疗的决定必须基于个体患者，从而确保不拒绝给予最需要的患者可能挽救生命的治疗。
