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目的通过对致死性肺栓塞(FPE)导致心脏骤停患者的临床特点的描述,结合系统文献回顾,总结FPE的救治要点,提高FPE的诊治水平。方法回顾分析2例FPE导致心脏骤停患者的救治过程。在Medline(1950~2014年)和EMbase(1980~2014年)两个文献检索系统中检索关于应用溶栓剂治疗FPE导致心脏骤停的文献,对FPE的治疗加以系统总结。结果 2例患者均为外科手术后发生FPE,经心肺复苏、溶栓及抗凝治疗好转,但其中1例患者在抗凝期间发生大出血。共检索到6篇关于FPE导致心脏骤停的文献,共分析72 473例患者,主要为肺栓塞所致心脏骤停或血流动力学不稳定的高危肺栓塞患者,溶栓药物为重组组织型纤溶酶原激活物或链激酶,各研究中给药的方式和剂量均不相同。总体来讲,溶栓治疗可以缩短患者自主循环恢复的时间,提高患者的生存率,但是出血风险有所增加。结论 FPE导致心脏骤停有很高的病死率,临床医生必须及时甄别。早期应用溶栓治疗非常重要,可以改善患者预后。
OBJECTIVE: To describe the clinical features of patients with cardiac arrest caused by fatal pulmonary embolism (FPE) and to review the systematic literature review and summarize the main points of treatment of FPE and improve the diagnosis and treatment of FPE. Methods Retrospective analysis of two cases of FPE caused cardiac arrest in patients with the treatment process. The literature on the use of thrombolytic agents in the treatment of FPE for cardiac arrest was searched in two literature retrieval systems, Medline (1950-2014) and EMbase (1980-2014), and the treatment of FPE was systematically summarized. Results All 2 patients underwent FPE after surgery. After cardiopulmonary resuscitation, thrombolysis and anticoagulation therapy improved. However, 1 patient developed massive hemorrhage during anticoagulation. A total of 6 articles on FPE-induced cardiac arrest were retrieved and 72 473 patients were analyzed, mainly in high-risk pulmonary embolism patients with cardiac arrest or hemodynamic instability caused by pulmonary embolism. The thrombolytic drugs were recombinant tissue-type Plasminogen activator or streptokinase, the way of administration and dose of each study are not the same. In general, thrombolytic therapy can shorten the recovery time of patients with spontaneous circulation, improve patient survival, but the risk of bleeding increased. Conclusion FPE causes a high mortality rate of cardiac arrest, clinicians must be promptly screened. Early thrombolytic therapy is very important, can improve the prognosis of patients.