頸髓損傷患者併發急性肺與支氣管動脈栓塞

Acute Pulmonary and Bronchial Artery Embolism in a Patient with Cervical Spinal Cord Injury

陳秋曲(Chiu-Chu Chen) ； 賴美玉(Mei-Yu Lai) ； 劉泰程(Tai-Chung Liou) ； 蘇俊郎(Chun-Lang Su)

《台灣醫學》 20卷5期 (2016/09) Pp. 460-465

https://doi.org/10.6320/FJM.2016.20(5).3

摘要

脊髓損傷後有很高比例會併發靜脈血栓栓塞症(venous thromboembolism)，如有發生此症則致死率與致病率相當高。發生下肢靜脈血栓合併肺栓塞時會出現低血壓、低血氧等症狀，嚴重時可能需要進行心肺復甦術。本案例為一位54歲男性，因車禍意外導致頸椎C5-7椎間盤突出合併頸髓壓迫造成四肢癱瘓住院復健，進行復健運動時患者突感覺呼吸困難、臉色蒼白、冒冷汗、意識逐漸變模糊，血壓下降並呈現休克及血氧下降現象。醫療團隊緊急處置，並安排血液生化檢查、動脈血液氣體分析、D-dimer檢測、心電圖、心臟超音波與電腦斷層掃描，確認診斷患者為下肢靜脈血栓合併肺栓塞，施以抗凝血劑進行治療，病況穩定後轉回病房。

關鍵字

頸髓損傷 ； 肺栓塞

並列摘要

A high proportion of patients with spinal cord injury would develop the complication of pulmonary embolism. The mortality rate of pulmonary embolism is very high during rehabilitation. When pulmonary embolism occurred, hypotension, desaturation and etc…, were also found. Emergent cardiopulmonary resuscitation was needed if the situation was quite severe. We reported a 54-year-old man who had cervical C5- C7 disc herniation and spinal cord compression with lower limbs paralysis underwent rehabilitation regularly. On the same day when the rehabilitation was taken, he suffered from dyspnea, pale-looking, cold sweating, consciousness disturbance, hypotension and hypoxia. After the evaluation and treatment, including blood examination, arterial blood gas analysis, D-dimer testing, electrocardiogram, cardiac ultrasound, computed tomography, oxygen therapy and vasopressor, pulmonary embolism was impressed and he was transferred to the intensive care unit immediately. At ICU, he took thrombolytic agent and was transferred to general ward for the stable condition.

並列關鍵字

injury of the cervical spinal cord ； pulmonary embolism

參考文獻

Hsu YC, Lin SC: Thrombolytic therapy improves a patient with massive pulmonary embolism and unstable hemodynamics: a case report. Taiwan Crit Care Med 2010;11:134-9."

Li CY, Yu YB: Incidence and characteristics of pulmonary embolism in Taiwanese patients: impact of active malignancy from a 5-year single center experience. Tung's Med J 2011;5:29-37."

盧介聖、陳俊彰、馮南雄等：肺栓塞早期診斷-兩案例報告。台灣醫界 2010;53:15-18。[Lu CS, Chen JJ, Fen NH, et al: Early diagnosis of pulmonary embolism-two case reports. Taiwan Med J 2010;53:15-18.]"

彭錦池、林作彥、葉時烊等：次大量肺栓塞：病例報告。台灣急診專科醫師期刊 2012;4:75-8。[Peng CT, Lin TY, Yeh SY, et al: Submassive pulmonary embolism: a case report. J Taiwan College Emerg Physician 2012;4:75-8.]"

陳郁安、張坤正：肺栓塞-從病理機轉到診斷治療策略。內科學誌 2014;25:307-15。[Chen YA, Chang KC: Pulmonary embolism: from pathogenesis to diagnosis and treatment. J Intern Med Taiwan 2014;25:307-15.] doi: 10.6314/JIMT.2014.25(5).01"