目的 总结术中急性致死性肺动脉栓塞的抢救经验,提高其早期诊断率和抢救成功率。
方法 回顾分析2014年3月和2015年7月2例术中突发急性致死性肺动脉栓塞患者的临床资料。术中在麻醉科和胸心外科等科室密切配合下急诊行肺动脉介入碎栓溶栓术,术后观察生命征、Miller指数、平均肺动脉压(mPAP)与动脉血氧饱和度(SaO2)的变化,以及肺动脉开通情况和并发症。
结果 术中经麻醉科、血管外科和胸心外科等科室的密切协作,2例患者均成功救治。术后患者血氧、心率、血压、呼吸等生命征明显改善,造影显示肺动脉明显开通,Miller指数从0.49±0.03降至0.25±0.05,SaO2从(45±5)mm Hg上升到(80±6)mm Hg,治疗前后差异有统计学意义(P＜0.05)。术后均给予下腔静脉滤器安置及持续抗凝、抗血小板聚集等治疗,分别随访18个月和3个月,疗效持续,未见并发症和复发。
结论 术中急性致死性肺栓塞病情危急,需加强及时诊断意识,需相关科室的通力协作,并迅速给予肺动脉介入溶栓治疗,能立即开通肺循环梗阻,降低肺动脉压,迅速改善心、肺血流动力学状态,疗效快速显著,值得临床推广。
Citation：
魏立春, 侯培勇, 苏奕明, 李祺熠, 郑毅. 多科协作成功抢救术中致死性肺动脉栓塞的经验及体会(附两例报告). Chinese Journal of Respiratory and Critical Care Medicine, 2016, 15(4): 406-409. doi: 10.7507/1671-6205.2016095
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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. 许小毛, 叶晓华,乔立松,等.致死性肺栓塞导致心脏骤停两例并文献复习.中国呼吸与危重监护杂志,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. 张福先, 金英姬,马佐田,等.肢体静脉血栓形成与肺动脉栓塞的关系探讨.中华结核和呼吸杂志,2000,23:531-533.
- 12. 钱咏梅. 股静脉穿刺术后压迫时间与止血效果的观察.临床护理杂志,2010,9:73-74.
