一位急性肺栓塞行超音波輔助血栓溶解術之病例報告

Ultrasound Assisted Thrombolysis for Acute Pulmonary Embolism: A Case Report

肺栓塞是一種困難診斷致命疾病，若未即時診斷或妥善治療，其死亡率極高。本篇是探討一位47歲男性因下肢深部靜脈栓塞導致嚴重肺栓塞，經超音波輔助血栓溶解治療之病例報告。運用觀察、病史收集、實驗室檢查、理學檢查、鑑別診斷結果進行整體性評估，經心臟超音波及電腦斷層檢查，得以確診肺栓塞，因評估個案血液動力學不穩定，提供超音波輔助血栓溶解治療，藉由放置微導管且定位到雙側肺動脈栓塞處，進行低劑量的溶栓藥物使用，以達成功溶栓，使得個案疾病獲得控制及改善，順利轉出加護病房，再經由跨團隊合作進行持續追蹤及相關照護，成功讓個案回歸正常生活。藉此案例經驗分享讓臨床醫護人員更了解此疾病進程及術後相關照護，達到即時治療，避免致死率發生。建議未來院內可發展肺栓塞治療選擇之醫病共享決策，達到有效及省時的決策，以提升照護品質。

Pulmonary embolism is a fatal disease that is difficult to diagnose. If it is not diagnosed immediately or properly managed, a high mortality rate will result. This case report described a 47-year-old man with massive pulmonary embolism and unstable hemodynamics due to deep venous thrombosis of the lower extremities. The patient received ultrasound-assisted thrombolysis. With observation, medical history collection, laboratory examination, physical examination, and differential diagnosis results for overall evaluation, the diagnosis of pulmonary embolism was confirmed by cardiac ultrasound and computer tomography. Due to the patient’s hemodynamic instability, ultrasound-assisted thrombolysis interventional therapy combined with low-dose thrombolytic drugs was prescribed. The patient’s clinical condition was improved and smoothly transferred from the intensive care unit to the ordinary ward. With a multidisciplinary team approach and persistent care, the patient successfully returned to a normal life. Through the sharing of case experience, clinical medical staff can better understand the disease process and post-operative care to achieve immediate treatment and avoid mortality. We recommend implementation of shared decision-making for the treatment choices of pulmonary embolism, which will achieve effective and timesaving decisions and improve the quality of care.