每日一题_2022.07.10

Which of the following patients is most likely to derive benefit from systemic thrombolytic therapy for pulmonary embolism?

A. 42-year-old woman, body mass index (BMI) 45, with remote bariatric surgery and a normal ECG, elevated troponin and B-type natriuretic peptide, with echocardiogram showing D-shaped right ventricle

B. 67-year-old man, BMI 28, with history of smoking and chronic obstructive pulmonary disease, elevated troponin, T-wave inversion, who takes norepinephrine for systolic blood pressure (SBP) less than 90 mm Hg

C. 75-year-old woman, BMI 32, with diabetes, hypertension, knee replacement two weeks ago, elevated troponin, and T-wave inversion

D. 58-year-old man, BMI 25, with hypertension, previous intracranial hemorrhage, elevated troponin, T-wave inversion, and on norepinephrine for SBP less than 90 mm Hg

答案解析：

在存在低血压、收缩压 < 90 mmHg（大面积肺栓塞 [PE]）和低出血风险的情况下，建议使用全身溶栓治疗肺栓塞。与血流动力学不稳定的患者相比，有右心室功能障碍体征（生物标志物、超声心动图变化）的患者不太可能获得直接获益。出血评价包括审查相对和绝对禁忌症以及导致出血的因素（即年龄、性别、人种）。B、D患者均有大面积PE，但 D 患者有溶栓的绝对禁忌症。

正确答案：B