肺血栓栓塞症(PTE)是临床急症,病死率较高.积极的溶栓治疗是成功抢救PTE的关键,但部分PTE高危因素亦为溶栓禁忌证,可能加重溶栓过程中的出血风险.本研究回顾性分析存在溶栓禁忌证并进行溶栓治疗的PTE患者10例,PTE发生前均存在并存疾病,其中胸腹部大手术后4例,急性脑梗死2例,蛛网膜下腔出血2例,剖宫产术后1例,活动性阴道出血1例.患者均给予静脉溶栓或介入溶栓治疗,9例好转,1例死亡.对临床诊断明确的高危PTE患者,即便存在溶栓禁忌证,也应强调以降低肺动脉压和改善右心室功能为急诊治疗的核心,结合临床情况对患者进行综合评价,选择以溶栓为首要治疗措施的积极治疗方案.%Pulmonary thromboembolism(PTE) is a clinically acute disease with a high fatality rate.Active thrombolytic therapy is the key to the successful rescue of PTE, but some of the PTE high risk factors are contraindications to thrombolysis, which may aggravate the risk of bleeding during thrombolysis.We reviewed 10 cases of PTE with contraindications to thrombolysis undergoing thrombolytic therapy.All of them had comorbidities before the onset of PTE(4 with major thoracic and abdominal surgery,2 with acute cerebral infarction,2 with subarachnoid hemorrhage,1 with caesarean section, and 1 with active vaginal bleeding) and received intravenous thrombolysis or interventional thrombolysis.Nine of them discharged with a better condition,but the other 1 died.For a high-risk PTE patient with confirmed diagnosis, even if he has contraindications to thrombosis, rapidly decreasing pulmonary arterial pressure and improving right ventricular function are still of critical importance during the emergency treatment, so thrombolytic therapy should be given to him as the primary regimen for positive treatment based on comprehensive assessment of the patient's conditions.
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