急性脊髓損傷併發肺栓塞：病例報告

肺栓塞係一具有生命威脅性的疾病，且其臨床表現相當多樣化而不易診斷。目前國內尚無有關急性脊髓損傷病人併發肺栓塞的臨床報告及統計資料，但根據國外的統計報告及文獻指出，肺栓塞在急性脊髓損傷病人的發生率要比一般族群來得高，並且早期預防和早期診斷及治療，可以降低其發生率及死亡率。因此，急性脊髓損傷病人若有遲發的新症狀，應注意臨床上肺栓塞發生的可能性。本文報告一例17歲女性病人，因車禍發生急性脊髓損傷，造成下肢癱瘓，一個月後於接受下肢被動閣節活動運動時，突然發生頭暈、冒冷汗、胸部壓迫感、休克及意識喪失。經急救後病人回復清醒，情況轉為穩定。心電圖顯示SQT變化；胸部X光有心臟擴大情形；心臟超音波發現右心房與右心室擴大，肺高壓及三尖瓣逆流；肺臟灌注掃瞄顯示左肺下葉有灌注缺陷。五日後肺血管攝彰證實左肺動脈的下枝及左肺lingual lobe下部分枝有血管栓塞。因雙下肢靜脈血管攝影並未發現有靜脈栓塞情形．所以僅予以口服抗血小板製劑ticlopidine治療。後來病人情況穩定．並無肺栓塞的再發。

關鍵字

肺栓塞；脊髓損傷；血栓栓塞

並列摘要

Pulmonary embolism (PE) is a life-threatening disease with variable manifestations and thus early diagnosis is difficult among the spinal cord injury (SCI) patients. There are still no clinical reports or statistical data about the PE in SCI patients in Taiwan. However, the incidence of PE in SCI patients was higher than that in general population according to the reports in western countries, and early prevention, diagnosis and treatment were documented to reduce the morbidity and mortality. So the doctor should keep alert to the possible PE in the SCI patients especially when there are new-onset symptoms or signs. Here we present a 17-year-old female, suffering from acute SCI with paraplegia in a traffic accident, who developed sudden onset of dizziness, diaphoresis, chest compression sensation, shock and then loss of consciousness during passive range of motion exercise one month after the injury. Her condition got spontaneous recovery twenty minutes later after first-aid treatment with intravenous fluid supply and Dopamine infusion, and soon became stable. Pulmonary angiogra-phy confirmed the diagnosis of PE at lower branch of left pulmonary artery and the branch to lower segment of lingual lobe five days later. The patient received oral antiplatelet agent (Ticlopidine) only since venography of both lower limbs did not show any thrombus in them. She continues receiving rehabilitation program and there has been no recurrence of PE thereafter.

並列關鍵字

pulmonary embolism ； spinal cord injury ； thromboembolism

國際替代計量

急性脊髓損傷併發肺栓塞：病例報告

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