- 期刊
Successful Resuscitation of Patients with Acute Massive Pulmonary Embolism Using Endovascular or Surgical Embolectomy and ECMO Support
使用葉克膜置入術合併血管腔內導管血栓清除術或外科肺動脈血栓切除術，救治急性大量肺栓塞合併心肺衰竭
摘要
前言：急性大量肺栓塞合併心肺衰竭是死亡率極高的急重症疾病，若能及時診斷與積極治療，使用葉克膜置入術，合併血管腔內導管血栓清除術或外科肺動脈血栓切除術，可以提高存活率，但此治療方式並未有一致的標準。本篇提出我們的經驗，使用葉克膜置入術合併血管腔內導管血栓清除術或外科肺動脈血栓切除術，救治急性大量肺栓塞合併心肺衰竭。方法：自2011年6月至2012年9月，共有6位女性病患（23-76歲，平均53.3歲），診斷為急性大量肺栓塞，合併呼吸衰竭；低血氧（n=6）或心臟停止（n=5）。所有病患皆接受葉克膜置入術。另外接受外科肺動脈血栓切除術（n=1），或血管腔內導管血栓清除術（n=5）。所有病患皆接受肺栓塞指標評估（simplified pulmonary embolism severity index, sPESI）、電腦斷層與心臟超音波診斷。結果：一位病患死於葉克膜置入術的合併症，大量後腹腔出血及血腫。二位病患死於多重器官衰竭。三位病患成功脫離葉克膜，復原良好出院，門診追蹤。結論：及時診斷治療且積極的使用葉克膜置入術，並合併血管腔內導管血栓清除術或外科肺動脈血栓切除術，可以拯救急性大量肺栓塞合併心肺衰竭的危急病患，提高存活率。
並列摘要
Purpose: Acute massive pulmonary embolism (PE) is frequently a desperate situation, but rapid diagnosis and aggressive therapy with endovascular or surgical embolectomy supported by extracorporeal membrane oxygenation (ECMO) may be lifesaving. However, the management is not standardized. This report detailed our experience with rapid diagnosis of massive PE patients and early ECMO support in severely compromised patients. Methods: Between June 2011 and September 2012, 6 female patients (aged from 23 to 76 years, with a mean of 53.3 years) were diagnosed as having massive PE with either acute irreversible oxygenation failure (n=6) or cardiac arrest (n=5). All patients required ECMO support. They were treated with surgical embolectomy (n=1), Angiojet aspiration (n=1), and endovascular embolectomy (n=4). All patients were evaluated as high risk using the simplified Pulmonary Embolism Severity Index (sPESI),1 and were classified and diagnosed with the aid of chest CT, echocardiogram, and pulmonary angiography. Results: One patient died from an ECMO cannula insertion complication of massive retroperitoneal hematoma and bleeding, and 2 patients expired due to multi-organ failure. Three were weaned from ECMO and were discharged; they were in good condition at followup. Conclusion: Aggressive endovascular or surgical pulmonary embolectomy with ECMO support appears to be beneficial for massive PE with acute cardiopulmonary failure.
延伸閱讀
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