Kuisma M, Silfvast T, Voipio V, Malmström R
Helsinki City EMS, Finland.
Resuscitation. 1998 Jul;38(1):47-50. doi: 10.1016/s0300-9572(98)00066-5.
A 52-year-old previously healthy man experienced acute severe dyspnoea after suffering from gastroenteritis for 3 days. After arrival of the ambulance, cardiac arrest with an initial rhythm of electro mechanical dissociation occurred. Circulation was restored after 10 min of cardiopulmonary resuscitation but soon cardiac arrest reoccurred. Based on a strong clinical suspicion of massive pulmonary embolism, thrombolytic treatment with heparin 5000 IU and reteplase 20 U, given as single boluses and heparin was continued as an infusion 1000 IU h(-1). After 7 min of continued resuscitation, circulation was restored and after 40 min the vital functions began to stabilize, thus indicating pulmonary reperfusion. The diagnosis of pulmonary embolism was confirmed by a ventilation-perfusion scan and by spiral computerised tomography. The patient was discharged from intensive care after 2 days with a cerebral performance category I. Based on previous calculations, the annual number of patients who present with massive pulmonary embolism leading to cardiac arrest (and thus who would theoretically be candidates for thrombolytic treatment) was estimated to be 0.7/100000 inhabitants in this emergency medical services system.
一名52岁、既往健康的男性在患肠胃炎3天后出现急性严重呼吸困难。救护车到达后，发生心脏骤停，初始心律为电机械分离。经过10分钟的心肺复苏后循环恢复，但很快心脏骤停再次发生。基于强烈的临床怀疑为大面积肺栓塞，给予肝素5000 IU和瑞替普酶20 U进行溶栓治疗，均为单次推注，随后肝素以1000 IU/h的速度持续静脉输注。持续复苏7分钟后循环恢复，40分钟后生命体征开始稳定，提示肺再灌注。通气-灌注扫描及螺旋计算机断层扫描确诊为肺栓塞。患者在2天后以脑功能分级I级从重症监护病房出院。根据之前的计算，在这个紧急医疗服务系统中，每年因大面积肺栓塞导致心脏骤停（因此理论上为溶栓治疗候选者）的患者人数估计为每10万居民中有0.7例。
