肺栓塞溶栓治疗新理念

溶栓治疗是急性肺栓塞患者病情危重时挽救生命的重要治疗措施。虽然荟萃分析显示急性肺栓塞患者可从溶栓治疗中获益, 但在中危肺栓塞患者中给予溶栓, 由于出血风险的升高而未能降低死亡率。目前指南推荐在合并心搏骤停、梗阻性休克或持续性低血压的高危肺栓塞患者中给予溶栓治疗。溶栓治疗最主要的风险在于增加出血发生率, 尤其是颅内出血的发生率, 其亦是限制溶栓治疗广泛应用的主要原因。重组组织型纤溶酶原激活剂是目前应用最为广泛的溶栓药物, 疗效优于尿激酶和链激酶。一些减量溶栓研究获得了比较正面的结果, 但仍需进一步扩大研究规模加以验证。超声辅助导管溶栓是目前研究最多的局部溶栓技术, 在某些特定患者中可尝试应用。

New Principles for Thrombolysis in Pulmonary Embolism

Thrombolysis is an important treatment in critical patients with acute pulmonary embolism (PE). Although meta-analysis has shown that acute PE patients benefit from thrombolysis, the mortality is not reduced when thrombolysis is applied in patients with PE of intermediate risk due to the increased bleeding risk. Guidelines recommend that thrombolysis should be applied in high-risk PE with cardiac arrest, obstructive shock, or persistent hypotension. The most important risk of thrombolysis is bleeding, especially cranial bleeding, which restricts the wide use of thrombolysis. Recombinant tissue-type plasminogen activator is the most widely used thrombolytic agent, which is superior to urokinase and streptokinase. Some studies on reduced-dose thrombolysis achieved advantageous results, but more large-scale studies are needed. Ultrasound-assisted thrombolysis is a widely studied catheter-directed thrombolytic technique, and can be applied in some specific patients.