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題名 | Successful Delayed Thrombolytic Therapy in a Patient with Massive Pulmonary Embolism=延遲施予血栓溶解劑成功治療嚴重肺栓塞病患之一病例報告 |
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作者 | 趙庭興; 蔡良敏; 鄭正鎧; 李貽恆; 蔡惟全; 林立人; 陳志鴻; | 書刊名 | 臺灣醫學會雜誌 |
卷期 | 97:9 1998.09[民87.09] |
頁次 | 頁638-641 |
分類號 | 418.2325 |
關鍵詞 | 血栓溶解劑; 肺栓塞病患; Pulmonary embolism; Thrombolytic therapy; |
語文 | 英文(English) |
英文摘要 | 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. |
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