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急性主動脈剝離經緊急手術及體外循環後合併急性呼吸窘迫症候群成功治療經驗：一病例報告
A Successful Treatment of Acute Respiratory Distress Syndrome after Emergent Operation with Cardio-Pulmonart Bypass for Acute Aortic Dissection: A Case Report
摘要
體外循環（Cardiopulmonary bypass）後產生急性呼吸窘迫症候群（Acute respiratory distress syndrome, ARDS），並不多見，其發生率僅約1%～2.5%，但發生ARDS後之死亡率甚高，其治療對心臟外科醫師是一大挑戰。本病例為－55歲男性，因胸痛入院，經診斷為急性主動脈剝離A型（Acute aortic dissection, Standford type A），接受緊急升主動脈重建術及主動脈瓣膜修補手術治療。病人於術後第3天併發ARDS，經使用Pentoxifylline（PTX）治療，血氧分壓及臨床症狀明顯改善。病人於治療後第9日順利脫離呼吸器之使用，恢復良好。本文擬藉回顧文獻，探討PTX治療ARDS之相關原理，並針對體外循環後產生ARDS之相關機轉提出討論。
並列摘要
Acute respiratory distress syndrome (ARDS) following cardiopulmonary bypass is less common clinically with an incidence about 1%-2.5%, while the death rate due to ARDS is rather high. The article reports an emergency case of a 55-year-old man who was hospitalized for acute aortic dissection (Standford type A). The patient underwent emergent reconstruction of ascending aorta and aortic valve repair .but ARDS developed three days after the operation. After Pentoxifylline therapy, arterial oxygen tension and clinical symptoms had improved rapidly. Ventilator was not necessary nine days after the Pentoxifylline therapy and the patient made a good recovery. We review the literatures concerning the role of Pentoxifylline in treatment of ARDS and the pathogenesis of ARDS following cardiopulmonary bypass.
延伸閱讀
- Hong, C. L., Ho, A. C., Liu, H. P., Chung, H. S., Chen, C. H., Tso, A. S., & Yang, M. W. (2001). 在胸主動脈剝離手術中運用經食道心臓超音波來診斷在體外心肺循環下發生主動脈真腔漸被壓迫的病例報告. Acta Anaesthesiologica Sinica, 39(4), 183-187. https://doi.org/10.6955/AAS.200112.0183
- 王逸思、姚亭羽（2021）。A型主動脈剝離術後合併腔室症候群患者之照護經驗。彰化護理，28(1)，29-41。https://doi.org/10.6647/CN.202103_28(1).0005
- 蔡谷蘭、謝克瑛、謝景仁（2019）。【論文摘要】運用跨領域團隊照護成功脫離呼吸器之經驗以冠狀動脈繞道手術為例。呼吸治療，18(1)，135-135。https://doi.org/10.6269/JRT.201907_18(1).0054
- Yuan, P. J., & Wong, W. K. (2018). Acute Myocardial Infarction and Concomitant Stroke as the Manifestations in a Patient with Type A Aortic Dissection: A Case Report with Three Years of Follow-Up. Acta Cardiologica Sinica, 34(1), 104-107. https://doi.org/10.6515/ACS.201801_34(1).20170815A
- Fiddler, M., Avadhani, S. A., & Marmur, J. D. (2015). Guide Catheter-Induced Aortic Dissection Complicated by Pericardial Effusion with Pulsus Paradoxus: A Case Report of Successful Medical Management. Case Reports in Medicine, 2015(), 314-319-079. https://doi.org/10.1155/2015/480242