Thrombolytic Therapy Improves a Patient with Massive Pulmonary Embolism and Unstable Hemodynamics: A Case Report

肺栓塞合併血流動力學不穩定患者接受血栓溶解治療獲得改善：病例報告

許楹奇(Ying-Chi Hsu) ； 林世章(Shih-Chang Lin)

《重症醫學雜誌》 11卷2期 (2010/08) Pp. 134-139

https://doi.org/10.30035/TCCM.201008.0009

摘要

在靜脈血栓栓塞症(venous thromboembolism)中包括深層靜脈血栓(deep venous thrombosis)及肺栓塞(pulmonary embolism)，其主要治療爲使用抗凝血治療。當血流動力學不穩定時，包括持續低血壓、嚴重低血氧、心因性休克、右心衰竭、需要緊急實施心肺復甦術及大量肺栓塞，立即給予血栓溶解治療可以改善患者血流動力學。我們報告一位患者，藉由胸部電腦斷層診斷大量肺栓塞合併持續低血壓，而且呼吸衰竭需要靠非侵襲性正壓呼吸器支持。在使用血栓溶解治療後24小時內，胸部電腦斷層顯示血栓有部分溶解，患者臨床狀況也獲得改善。

關鍵字

靜脈血栓性栓塞 ； 紳部靜脈血栓 ； 肺栓塞 ； 血栓溶解治療

並列摘要

Anticoagulation is the mainstay of therapy in patients with venous thromboembolism (VTE), which includes deep venous thrombosis (DVT) and pulmonary embolism (PE). When hemodynamics are unstable, as in persistent hypotension (BP＜90mm Hg or a drop in systolic blood pressure of ≧40mm Hg from baseline), severe hypoxemia, cardiogenic shock, right ventricular dysfunction, circulatory collapse (including syncope or need for cardiopulmonary resuscitation), and massive pulmonary embolism, thrombolytic therapy may improve the unstable condition. Herein, we report the case of a patient who had massive PE with hypotension and pending respiratory failure under non-invasive positive pressure ventilation (NIPPV) support. Thrombolytic therapy was administered and the clinical condition improved within 24 hours. Chest computed tomography (CT) revealed partial remission of PE.

並列關鍵字

Venous thromboembolism VTE ； Deep venous thrombosis DVT ； Pulmonary embolism PE ； Thrombolytic therapy