Agarwal Amitesh, Kollar Andras, Duarte Alexander G
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA.
Department of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Texas, USA ; Deceased.
Pulm Circ. 2015 Dec;5(4):726-9. doi: 10.1086/683688.
Continuous prostanoid infusion is an established treatment for pulmonary arterial hypertension that has led to improvements in symptoms, exercise tolerance, and survival. Patients with pulmonary arterial hypertension (PAH) who develop sepsis frequently experience clinical and hemodynamic deterioration associated with poor outcomes. Successful management of sepsis involves identification of the source of infection, early antimicrobial administration, judicious fluid resuscitation, and continuation of specific PAH therapies. We describe successful management of a patient with idiopathic PAH receiving chronic intravenous prostacyclin therapy who developed an aortic root abscess due to Clostridium perfringens requiring emergent aortic root repair. Management involved imaging studies, removal of potential sources with administration of intravenous antibiotics, and cautious fluid administration with hemodynamic monitoring. A multidisciplinary group led by a PAH specialist worked cohesively before, during, and after surgical intervention and achieved a successful outcome.
持续输注前列环素是一种已确立的治疗肺动脉高压的方法，已使症状、运动耐量和生存率得到改善。患有肺动脉高压（PAH）的患者发生脓毒症时，常出现与不良预后相关的临床和血流动力学恶化。脓毒症的成功管理包括识别感染源、早期给予抗菌药物、合理的液体复苏以及继续特定的PAH治疗。我们描述了一名接受慢性静脉注射前列环素治疗的特发性PAH患者的成功管理案例，该患者因产气荚膜梭菌感染发生主动脉根部脓肿，需要紧急进行主动脉根部修复。管理措施包括影像学检查、静脉使用抗生素以消除潜在感染源，以及在血流动力学监测下谨慎进行液体输注。由一名PAH专家领导的多学科团队在手术干预前、手术期间和手术后紧密合作，取得了成功的结果。
