Bussières Jean S
Department of Anesthesiology, Laval University Heart and Lung Institute, Laval Hospital, Québec City, Canada.
Curr Opin Anaesthesiol. 2007 Feb;20(1):48-52. doi: 10.1097/ACO.0b013e32801158a9.
Pulmonary artery rupture is probably the most devastating complication associated with the use of the pulmonary artery catheter. This rare but disastrous situation requires a clear intervention plan.
The initial presentation of pulmonary artery ruptures may be as obvious as a massive pulmonary hemorrhage or as subtle as a cough associated with minimal hemoptysis, or it may even be totally asymptomatic. A patient presenting any clinical manifestation of pulmonary artery rupture may develop a pulmonary artery false aneurysm, which is the accumulation of blood in an aneurismal sac compressed by lung parenchyma. This condition requires intervention because delayed hemorrhage may occur and recurrence can be massive and fatal. Following an initial episode of suspected pulmonary artery rupture, the patient should undergo immediate radiological investigation. If a diagnosis of pulmonary artery false aneurysm is confirmed, selective angiographic embolization helps reduce morbidity and mortality.
The incidence of pulmonary artery ruptures is probably underestimated because many hemoptysis episodes or radiological infiltrations associated with pulmonary artery catheter use are not investigated. Also, the natural evolution of the pulmonary artery false aneurysm is unknown. The incidence of spontaneous healing, bleeding recurrence or asymptomatic persistence is unknown following formation of a pulmonary artery false aneurysm.
肺动脉破裂可能是与使用肺动脉导管相关的最具毁灭性的并发症。这种罕见但灾难性的情况需要明确的干预计划。
肺动脉破裂的最初表现可能像大量肺出血一样明显，也可能像伴有少量咯血的咳嗽一样轻微，甚至可能完全无症状。出现肺动脉破裂任何临床表现的患者可能会形成肺动脉假性动脉瘤，即血液在被肺实质压迫的动脉瘤囊中积聚。这种情况需要干预，因为可能会发生延迟性出血，且复发可能大量且致命。在首次怀疑肺动脉破裂后，患者应立即接受影像学检查。如果确诊为肺动脉假性动脉瘤，选择性血管造影栓塞有助于降低发病率和死亡率。
肺动脉破裂的发生率可能被低估了，因为许多与使用肺动脉导管相关的咯血发作或影像学浸润并未得到调查。此外，肺动脉假性动脉瘤的自然演变尚不清楚。肺动脉假性动脉瘤形成后，自发愈合、出血复发或无症状持续的发生率也不清楚。
