Can pulmonary embolism be cured?

Pulmonary embolism is a relatively serious disease, and it is not uncommon for people to suffer from pulmonary embolism in life. The main clinical symptoms of this disease are closely related to mechanical obstruction of the pulmonary artery and may cause sudden death. The causes of sudden death include right heart failure, pulmonary hypertension, hypoxia, etc. At present, embolism is a more dangerous disease. Postoperative pulmonary embolism is also a rare complication. We must pay attention to preventing and controlling the occurrence of this disease.

Clinical manifestations of pulmonary embolism

Treatment for patients with massive pulmonary embolism or acute cor pulmonale includes timely oxygen inhalation, relief of pulmonary vasospasm, anti-shock, anti-arrhythmic, thrombolysis, anticoagulation and surgical treatment. For patients with chronic embolic pulmonary hypertension and chronic cor pulmonale, treatment mainly includes blocking the source of emboli, preventing re-embolism, performing pulmonary thromboendarterectomy, lowering pulmonary artery pressure and improving cardiac function.

1. Treatment of acute pulmonary embolism

(1) First aid measures: The first two days after the onset of pulmonary embolism are the most dangerous. The patient should be admitted to the ICU ward and have blood pressure, heart rate, respiration, electrocardiogram, central venous pressure and blood gas monitored continuously.

① General treatment: keep the patient quiet, warm, and oxygen inhaled; for sedation and analgesia, morphine, pethidine, and codeine may be given if necessary; antibiotics are used to prevent pulmonary infection and treat phlebitis.

② To relieve pulmonary vasospasm and coronary artery spasm caused by excessive vagal nerve tension, intravenous injection of atropine 0.5-1.0 mg, if it does not relieve the symptoms, repeat once every 1-4 hours. You can also give 30 mg of papaverine subcutaneously, intramuscularly or intravenously, once//h. This drug also has the effect of sedation and reducing platelet aggregation.

③ Anti-shock: Patients with combined shock should be given dopamine 5-10μg/(kg?min), dobutamine 3.5-10μg/(kg?min) or norepinephrine 0.2-2.0μg (kg?min) to quickly correct arrhythmias that cause hypotension, such as atrial flutter, atrial fibrillation, etc. Maintain mean arterial blood pressure>80mmHg, cardiac index>2.5 L/(min?m2) and urine output>50ml/h. At the same time, actively carry out thrombolytic and anticoagulant treatment to achieve rapid relief of the condition. It should be pointed out that 80% of deaths from acute pulmonary embolism occur within 2 hours of onset, so treatment and rescue must be carried out as soon as possible.

④ Improve breathing: If bronchospasm occurs, bronchodilators and mucolytics such as aminophylline, dihydroxypropyl theophylline (Cyclodex) can be used. You can also use 10-20 mg of phentolamine dissolved in 100-200 ml of 5%-10% glucose and drip intravenously to relieve bronchospasm and dilate pulmonary blood vessels. Patients with respiratory failure and severe hypoxemia can be treated with mechanical ventilation for a short period of time.

(2) Thrombolytic therapy: When thrombolytic therapy for acute pulmonary embolism was introduced to the medical community 30 years ago, it was a complex, heroic, and desperate last-ditch treatment that required huge human, material, and financial support. Although streptokinase and urokinase were approved by the U.S. Food and Drug Administration for the treatment of pulmonary embolism in 1977 and 1978, respectively, they were rarely used until the mid-1980s. The success of thrombolytic therapy for acute myocardial infarction has led to a re-examination of thrombolytic therapy for pulmonary embolism, and a subsequent series of clinical trials have made contemporary thrombolytic therapy for pulmonary embolism safer, faster, simpler and more effective.