Chao T H, Tsai L M, Teng J K, Li Y H, Tsai W C, Lin L J, Chen J H
Department of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
J Formos Med Assoc. 1998 Sep;97(9):638-41.
Pulmonary embolism can be a catastrophic event leading to early death or serious hemodynamic instability. Thrombolytic therapy, in addition to heparin therapy, may improve the clinical condition and reduce the chance of recurrent pulmonary embolism in some cases. However, the acceptable "time window" for thrombolytic therapy is not well documented, though it has been used successfully as late as 14 days after pulmonary embolism. Successful delayed thrombolytic therapy beyond this "time window" in patients with massive pulmonary embolism has not been reported. We report a case of massive pulmonary embolism in which thrombolytic therapy was delayed more than 1 month after symptom onset. A 56-year-old woman was taken to National Cheng Kung University Hospital because of an episode of recurrent syncope, followed by progressive shortness of breath of 1 month's duration. Hypoxemia and hemodynamic instability were noted on admission. Echocardiography and a lung perfusion scan provided strong evidence of pulmonary embolism. Subsequent pulmonary angiography confirmed the diagnosis of multiple pulmonary emboli. The patient received a standard dose of intravenous tissue plasminogen activator 7 days after admission because of persistent symptoms and hypoxemia. Her clinical condition dramatically improved after treatment. Follow-up imaging studies showed resolution of the emboli. She was discharged in good condition. This case suggests that delayed thrombolytic therapy in patients with massive pulmonary embolism can still be beneficial in selected cases, even if given more than 2 weeks after symptom onset.
肺栓塞可能是一种灾难性事件，可导致早期死亡或严重的血流动力学不稳定。除肝素治疗外，溶栓治疗在某些情况下可能改善临床状况并降低复发性肺栓塞的几率。然而，溶栓治疗可接受的“时间窗”尚无充分文献记载，尽管在肺栓塞后长达14天使用溶栓治疗仍取得了成功。在大面积肺栓塞患者中，超过这个“时间窗”进行成功的延迟溶栓治疗尚未见报道。我们报告一例大面积肺栓塞病例，其溶栓治疗在症状出现后延迟了1个多月。一名56岁女性因反复发作晕厥，随后进行性气短1个月而被送往国立成功大学医院。入院时发现低氧血症和血流动力学不稳定。超声心动图和肺灌注扫描提供了肺栓塞的有力证据。随后的肺血管造影证实了多发性肺栓塞的诊断。由于持续的症状和低氧血症，患者在入院7天后接受了标准剂量的静脉注射组织纤溶酶原激活剂。治疗后她的临床状况显著改善。随访影像学检查显示栓子溶解。她康复出院。该病例表明，大面积肺栓塞患者即使在症状出现2周后进行延迟溶栓治疗，在某些特定情况下仍可能有益。
