多科協作成功搶救術中致死性肺動脈栓塞的經驗及體會(附兩例報告)_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

魏立春 ,  侯培勇 , 蘇奕明 , 李祺熠 , 鄭毅

廣西醫科大學第四附屬醫院血管外科(廣西柳州 545005);

Corresponding?author：

侯培勇, Email: zxp19841223@126.com

Keywords：

肺動脈栓塞; 介入溶栓術; 多學科; 協作; 及時診治

DOI：

10.7507/1671-6205.2016095

Video：

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目的總結術中急性致死性肺動脈栓塞的搶救經驗,提高其早期診斷率和搶救成功率。方法回顧分析2014年3月和2015年7月2例術中突發急性致死性肺動脈栓塞患者的臨床資料。術中在麻醉科和胸心外科等科室密切配合下急診行肺動脈介入碎栓溶栓術,術后觀察生命征、Miller指數、平均肺動脈壓(mPAP)與動脈血氧飽和度(SaO₂)的變化,以及肺動脈開通情況和并發癥。結果術中經麻醉科、血管外科和胸心外科等科室的密切協作,2例患者均成功救治。術后患者血氧、心率、血壓、呼吸等生命征明顯改善,造影顯示肺動脈明顯開通,Miller指數從0.49±0.03降至0.25±0.05,SaO₂從(45±5)mm Hg上升到(80±6)mm Hg,治療前后差異有統計學意義(P＜0.05)。術后均給予下腔靜脈濾器安置及持續抗凝、抗血小板聚集等治療,分別隨訪18個月和3個月,療效持續,未見并發癥和復發。結論術中急性致死性肺栓塞病情危急,需加強及時診斷意識,需相關科室的通力協作,并迅速給予肺動脈介入溶栓治療,能立即開通肺循環梗阻,降低肺動脈壓,迅速改善心、肺血流動力學狀態,療效快速顯著,值得臨床推廣。

Citation： 魏立春, 侯培勇, 蘇奕明, 李祺熠, 鄭毅. 多科協作成功搶救術中致死性肺動脈栓塞的經驗及體會(附兩例報告). Chinese Journal of Respiratory and Critical Care Medicine, 2016, 15(4): 406-409. doi: 10.7507/1671-6205.2016095 Copy

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1. Torbicki A,Pettier A,Konstantinides S,et al.Guidelines on the diagnosis and management of acute pulmonary embolism:the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology(ESC).Eur Heart J,2008,29:2276-2315.
2. Andrzej C.Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of low molecular weight heparin-Gynecologicar ward retrospective analysis.Eur J Obstet Gynecol Reprod Biol,2002,100:223-226.
3. Geerts WH,Bergqvist D,Pineo GF,et al.Prevention of venous thromboembolism:American College of Chest Physicians Evidenced-Based Clinical Practice Guidelines.Chest,2008,133,381S-453S.
4. Laporte S,Mismetti P,Décousus H,et al.Clinical predictors for fatal pulmonary embolism in 15520 patients with venous thromboembolism:findings from the Registro Informatizado de la Enfermed and Trombo Embolica venosa (RIETE)Registry.Circulation,2008,117:1711-1716.
5. Carvalho Bricola SA,Paiva EF,Lichtenstein A.Fatal pulmonary embolism in hospitalized patients:a large autopsy-based matched case-control study.Clinics(Sao Paulo),2013,68:679-685.
6. Goran KP.Thrombolysis during cardiopulmonary resuscitation should be addressed in guidelines for pulmonary embolism.Eur Heart J,2008,29:3066-3067.
7. Logan JK,Pantle H,Huiras P,et al.Evidence-based diagnosis and thrombolytic treatment of cardiac arrest or periarrest due to suspected pulmonary embolism.Am J Emerg Med,2014,32:789-796.
8. Konstantinides SV,Torbicki A,Agnelli G,et al.2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism.Eur Heart J,2014,35:3033-3069.
9. 許小毛, 葉曉華,喬立松,等.致死性肺栓塞導致心臟驟停兩例并文獻復習.中國呼吸與危重監護雜志,2016,15:166-170.
10. Wang C,Zhai Z,Yang Y,et al.Efficacy and safety of low dose recombinant tissue-type plasminogen activator for the treatment of acute pulmonary thromboembolism:a randomized,multicenter,controlled trial.Chest,2010,137:254-262.
11. 張福先, 金英姬,馬佐田,等.肢體靜脈血栓形成與肺動脈栓塞的關系探討.中華結核和呼吸雜志,2000,23:531-533.
12. 錢詠梅. 股靜脈穿刺術后壓迫時間與止血效果的觀察.臨床護理雜志,2010,9:73-74.

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多科協作成功搶救術中致死性肺動脈栓塞的經驗及體會(附兩例報告)

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