超音波輔助併導管導引之血栓溶解治療肺動脈栓塞

Ultrasound-Assisted Catheter-Directed Thrombolysis for Pulmonary Thromboembolism

血栓栓塞為血管疾病第三大診斷群組，其中肺栓塞是危及生命的急性疾病，其併發休克、嚴重時甚至死亡可能在1小時之內發生。然而如能適時給予治療之介入例如血栓溶解治療，將可使死亡風險降低到3％－8％。過去在一般性執行血拴溶解治療時常有全身性併發症之可能，所以治療上有所限制。導管血拴溶解併用超音波輔助血拴溶解（ultrasound assisted thrombolysis, USAT），係利用超音波輔助肺拴塞溶解 的新型態治療方式，能增加治療成效。在臨床上這個新類型的治療具有一些優點例如較無全身併發症， 而完善的護理照護可以進一步減少USAT術後相關合併症的發生。完整的USAT照護包含術前說明簡介， 術後在加護病房階段密切監測神經狀況以及早期出血或腦中風等併發症的情形、監測及觀察穿刺部位是 否有出血情況、監測疼痛等問題；在一般病房的照護則要儘早恢復身體的活動，衛教出院後的出血風險， 筆者期望此篇簡介能提供臨床護理人員照顧肺栓塞病人進行血栓溶解治療之參考。 Pulmonary thromboembolism refers to one of the thromboembolism disorders, the third largest diagnostic group of vascular diseases. An acute, life-threatening condition, it carries a high risk of shock, and death can occur even within one hour in severe cases. Timely intervention such as thrombolytic therapy may reduce the risk of death to 3% - 8%. The conventional treatment with the systemic thrombolytic agent, however, can lead to complications, therefore limiting its applicability. Recently, a technique using catheter thrombolysis emerged and more advanced ''ultrasound-assisted catheter-directed thrombolysis (USAT)'' provides the acceleration of the dissolution of emboli with the aid of ultrasound technique. Its additional benefits include improved nursing care with fewer systemic and postoperative complications. Comprehensive USAT care encompasses preoperative instructions, the careful postoperative vigilance of neurologic status in the intensive care unit and complications such as cerebral hemorrhage and bleeding at the puncture site, pain control and so forth. Care at the general ward emphasizes early restoration of physical activities and health education about possible bleeding after discharge. We hope this article can provide a useful reference for clinical nurses to promote the familiarity about the care of patients receiving USAT for pulmonary thromboembolism.