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急性肺栓塞是内科急症常见病之一,大面积急性肺栓塞病情凶险,病死率高,约11%的患者死于病后1小时以内,因此快速有效的溶栓可以减少闭塞的血管床数量,恢复肺动脉向前血流,通过降低肺小动脉压力和肺血管阻力可改善右心功能和心脏射血,避免或减少因急性大面积肺栓塞导致的死亡,是治疗急性大面积肺栓塞的根本措施。我科自1997年～1999年4月采用大剂量尿激酶快速静脉溶栓治疗急性大面积肺栓塞10例,取得良好疗效且未见出血副作用,现报告如下。1 临床资料1.1 一般资料 10例病人均由急症门诊紧急收入CCU病房。其中男6例,女4例,年龄最大68岁,最小30岁。1.2 诊断依据(1)有引起肺栓塞的基础疾病存在。(2)突然胸痛、呼吸困难、咯血、发热、心悸等。(3)病变相应区有胸膜摩擦音,呼吸音减弱等。(4)X线有楔形,锥形和片状阴影。(5)心电图有肺动脉高压和右心房、右心室负荷过重等变化。(6)治疗后转归情况。
Acute pulmonary embolism is one of the most common medical emergencies. The large area of acute pulmonary embolism is extremely dangerous and has a high case fatality rate. About 11% of patients die within 1 hour after illness. Therefore, rapid and effective thrombolysis can reduce the number of occluded vascular beds, Recovery of pulmonary artery forward blood flow, by reducing pulmonary arterial pressure and pulmonary vascular resistance can improve right heart function and cardiac ejection, to avoid or reduce the death caused by acute large area pulmonary embolism is the fundamental treatment of acute large area pulmonary embolism . Our department from 1997 to April 1999 using high-dose intravenous thrombolytic rapid intravenous thrombolytic therapy of acute large area pulmonary embolism in 10 cases, and achieved good results and no bleeding side effects, are as follows. 1 Clinical data 1.1 General Information 10 patients were emergency outpatient emergency CCU ward. Including 6 males and 4 females, the oldest 68 years old, the youngest 30 years old. 1.2 Diagnosis (1) there is a basic cause of pulmonary embolism. (2) sudden chest pain, dyspnea, hemoptysis, fever, heart palpitations and so on. (3) the corresponding area of pleural friction fringing sound, breath sounds weakened. (4) X-ray wedge, cone and flaky shadows. (5) ECG has pulmonary hypertension and right atrium, right ventricular overload and other changes. (6) the outcome after treatment.