探讨静脉-动脉体外膜肺氧合（VA-ECMO）辅助下溶栓在治疗急性高危肺栓塞患者中的重要性及其经验分享。

经肺动脉CT血管成像（CTA）证实急性高危肺动脉栓塞患者1例，无明显原因及诱因下出现晕厥间断发作半天，伴胸闷憋气、心慌出汗、头晕等症状，血压低，需要大剂量去甲肾上腺素维持，脉搏血氧饱和度（SpO₂）降低，经胸部CT检查示右心明显增大，肺动脉CTA检查示双侧肺动脉主干及分支大量栓子，床旁心脏超声示左室收缩功能减低，右心明显增大，肺动脉压增高，明确诊断为急性重症肺栓塞，给予床旁ECMO治疗后行尿激酶溶栓治疗。

行ECMO治疗后患者生命体征平稳，血压及血氧饱和情况明显改善，4 d后平稳撤离ECMO，继续给予达肝素抗凝治疗，1周后复查肺动脉CTA示左侧肺栓子基本完全吸收，右侧肺栓部分吸收，2周后复查肺动脉CTA示双侧肺动脉栓子基本完全吸收，出院后继续给予华法林抗凝3个月。

ECMO对于可逆性肺部疾病具有一定优势，可为抢救急性高危肺栓塞赢得充裕的时间。VA-ECMO辅助溶栓治疗该类疾病安全有效，但在有效性评估中仍缺乏大样本的对照性研究，需要前瞻性管理研究的额外证据支持。

To share the importance and experience venous arterial extracorporeal oxygenation (VA-ECMO) -assisted thrombolysis in the treatment of acute high-risk pulmonary embolism patients.

One patient with acute high-risk pulmonary embolism was confirmed by pulmonary artery CT angiography (CTA). He was continuous break of syncope for half a day without obvious causes and precipitating factor. He with chest tightness, palpitation, sweating, dizziness and other symptoms, was need a large dose of Norepinephrine to maintain low blood pressure and pulse oxygen saturation was decreased. The transchest CT examination showed a significant enlargement of the right heart. Pulmonary CTA examination showed massive emboli in bilateral main and branch pulmonary arteries. Bedside cardiac ultrasound showed reduced LV systolic function, significant enlargement of the right heart and increased pulmonary artery pressure. The diagnosis of acute severe pulmonary embolism was made and bedside ECMO was treated with urokinase thrombolysis.

After ECMO treatment patients vital signs were stable, blood pressure and oxygen saturation condition improved significantly. ECMO was smoothly evacuated after four days and Dalteparin anticoagulant therapy was continued. One week later, pulmonary CTA showed almost complete absorption of the left pulmonary embolus and partial absorption of the right pulmonary plug. Two weeks later, reexamination of pulmonary artery CTA showed almost complete absorption of bilateral pulmonary artery emboli and warfarin anticoagulation was continued for three months after discharge.

ECMO has advantages for reversible pulmonary disease and won enough time to rescue acute high-risk pulmonary embolism. VA-ECMO adjuvant thrombolysis for acute high-risk pulmonary embolism is a safe and effective treatment measure but there is still a controlled study with large samples in the effectiveness evaluation and additional evidence from prospective management studies is needed.