Bennett Jeremy M, Pretorius Mias, Ahmad Rashid M, Eagle Susan S
Department of Anesthesiology Vanderbilt University Medical Center, Nashville, TN 37232.
Department of Anesthesiology Vanderbilt University Medical Center, Nashville, TN 37232.
J Clin Anesth. 2015 May;27(3):207-13. doi: 10.1016/j.jclinane.2014.10.007. Epub 2014 Dec 24.
Acute pulmonary embolism is a major cause of morbidity and mortality in patients presenting for emergent cardiac surgery with overall mortality ranging from 6% to as high as 85%. While the initial focus of treatment is nonsurgical or percutaneous interventions, surgical treatment continues to be a treatment for patients with refractory thrombus burden or cardiogenic shock. Our institution regularly performs surgical pulmonary embolectomy with improved outcomes compared to current reports. We thus performed a retrospective analysis of outcomes of pulmonary embolectomy patients and anesthetic management.
A retrospective review of 40 patients undergoing emergent pulmonary embolectomy over a 4 year period (2008-2012) at our institution was performed to assess for a 2nd period of critical instability.
The study was conducted at a tertiary, level 1, trauma university medical center.
The study was performed through chart review of patient hospital records.
No interventions were performed.
Anesthetic records were reviewed along with echocardiographic records and surgical reports to assess cardiac function, need for emergent cardiopulmonary bypass, and degree of patient morbidity.
A total of 40 patients were studied. Hemodynamic instability occurred in 12.5% of patients at time of induction requiring emergent cardiopulmonary bypass. Another 17% of patients who remained stable following induction developed subsequent instability requiring emergent cardiopulmonary bypass during pericardial opening or manipulation which has not been previously reported. One patient died during hospitalization. Patients who required emergent bypass following induction of general anesthesia tended to receive higher doses of induction drugs than the other groups. In patients who needed emergent bypass during pericardial manipulation there were no identifiable factors suggesting that these patients remain at risk despite a stable post-induction course.
急性肺栓塞是急诊心脏手术患者发病和死亡的主要原因，总体死亡率在6%至高达85%之间。虽然治疗的初始重点是非手术或经皮干预，但手术治疗仍然是血栓负荷难治或心源性休克患者的一种治疗方法。与目前的报告相比，我们机构定期进行手术肺动脉血栓切除术，结果有所改善。因此，我们对肺动脉血栓切除术患者的结局和麻醉管理进行了回顾性分析。
对我们机构在4年期间（2008 - 2012年）接受急诊肺动脉血栓切除术的40例患者进行回顾性研究，以评估第二个严重不稳定期。
该研究在一所三级、一级创伤大学医学中心进行。
该研究通过查阅患者医院记录进行。
未进行干预。
回顾麻醉记录以及超声心动图记录和手术报告，以评估心脏功能、急诊体外循环的需求以及患者的发病程度。
共研究了40例患者。诱导时12.5%的患者出现血流动力学不稳定，需要急诊体外循环。另外17%诱导后保持稳定的患者在打开心包或操作过程中出现后续不稳定，需要急诊体外循环，这在以前尚未有过报道。1例患者在住院期间死亡。诱导后需要急诊体外循环的患者往往比其他组接受更高剂量的诱导药物。在心包操作期间需要急诊体外循环的患者中，没有可识别的因素表明尽管诱导后过程稳定，但这些患者仍处于风险中。
