Jerjes-Sánchez C, Ramírez Rivera A, Arriaga Nava R, Pimentel Morales G
Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS, México, D.F.
Arch Inst Cardiol Mex. 1993 May-Jun;63(3):227-34.
We report the case of a 65 year old woman with no prior cardiac or pulmonary disease, who suffered pulmonary embolism (PE); diagnosis was made on the basis of the existence of risk factors, clinical, radiographic and electrocardiographic features, and a lung scan with perfusion defects and normal ventilation. PE was considered massive because the patient developed acute respiratory failure that required tracheal intubation and mechanical ventilation as well as obstructive shock, electrocardiographic and echocardiographic data of right ventricle overload, and pulmonary hypertension, with pulmonary artery pressure of 38 mmHg. She received an initial treatment with high doses (1,500,000 UI) and rapid infusion (1 hr) of intravenous streptokinase (SK) followed by heparin anticoagulation. Thereafter the hemodynamic disturbances improved and pulmonary artery pressure post-thrombolysis was 23 mmHg. In this report SK at high doses and rapid infusion showed effectiveness and security. We emphasize the usefulness of echocardiography as a diagnostic aid in patients with a previously healthy cardiopulmonary system, as well as the possible role of electrocardiogram as an early indicator of pulmonary reperfusion. This could be the first report of successful thrombolysis with high doses and rapid infusion of SK in massive PE.
我们报告一例65岁女性病例，该患者既往无心脏或肺部疾病，却发生了肺栓塞（PE）；根据存在的危险因素、临床、影像学和心电图特征以及灌注缺损且通气正常的肺部扫描做出诊断。该例PE被认为是大面积的，因为患者出现了急性呼吸衰竭，需要气管插管和机械通气，以及梗阻性休克、右心室负荷过重的心电图和超声心动图数据，还有肺动脉高压，肺动脉压为38 mmHg。她接受了初始治疗，静脉注射高剂量（150万国际单位）且快速输注（1小时）链激酶（SK），随后进行肝素抗凝治疗。此后血流动力学紊乱得到改善，溶栓后肺动脉压为23 mmHg。在本报告中，高剂量且快速输注的SK显示出有效性和安全性。我们强调超声心动图作为对既往心肺系统健康患者的诊断辅助手段的有用性，以及心电图作为肺再灌注早期指标的可能作用。这可能是首例关于高剂量且快速输注SK成功溶栓治疗大面积PE的报告。
