PDF(Pubmed)
Abstract：
Thrombolytic therapy has been the mainstay for patients with pulmonary embolism (PE). Despite being linked to a higher risk of significant bleeding, clinical trials demonstrate that thrombolytic therapy should be used in patients with moderate to high-risk PE, in addition to hemodynamic instability symptoms. This prevents the progression of right heart failure and impending hemodynamic collapse. Diagnosing PE can be challenging due to the variety of presentations; therefore, guidelines and scoring systems have been established to guide physicians to correctly identify and manage the condition. Traditionally, systemic thrombolysis has been utilized to lyse the emboli in PE. However, newer techniques for thrombolysis have been developed, such as endovascular ultrasound-assisted catheter-directed thrombolysis for massive and intermediate-high submassive risk groups. Additional newer techniques explored are the use of extracorporeal membrane oxygenation, direct aspiration, or fragmentation with aspiration. Because of the constantly changing therapeutic options and the scarcity of randomized controlled trials, choosing the best course of treatment for a given patient may be difficult. To help, the Pulmonary Embolism Reaction Team is a multidisciplinary, rapid response team that has been developed and is used at many institutions. Hence to bridge the knowledge gap, our review highlights various indications of thrombolysis in addition to the recent advances and management guidelines.
摘要：
溶栓治疗一直是肺栓塞（PE）患者的主要治疗方法。尽管与显著出血的较高风险有关，临床试验表明，溶栓治疗应用于中度至高危PE患者，除了血流动力学不稳定的症状。这防止了右心衰竭和即将发生的血液动力学崩溃的进展。由于演示文稿的多样性，诊断PE可能具有挑战性；因此，已经建立了指南和评分系统，以指导医生正确识别和管理病情。传统上,全身溶栓已用于溶解PE中的栓子。然而,已经开发了新的溶栓技术，如血管内超声辅助导管溶栓治疗大规模和中度-高度次大规模危险组。探索的其他新技术是使用体外膜氧合，直接抽吸,或带有抽吸的碎片。由于治疗方案的不断变化和随机对照试验的稀缺性，为特定患者选择最佳治疗方案可能很困难。为了帮助,肺栓塞反应小组是一个多学科,快速反应团队已经开发并在许多机构使用。因此，为了弥合知识差距，除了最新进展和管理指南外,我们的综述还重点介绍了溶栓的各种适应症.
