体外膜肺氧合、肺动脉血栓切除术及右心室辅助装置治疗大面积肺栓塞
Extracorporeal Membrane Oxygenation, Pulmonary Embolectomy, and Right Ventricular Assist Device for Massive Pulmonary Embolism.
作者信息
Lodewyks Carly L, Bednarczyk Joseph M, Mooney Owen T, Arora Rakesh C, Singal Rohit K
机构信息
Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Section of Critical Care, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
出版信息
Can J Cardiol. 2017 Jul;33(7):950.e7-950.e9. doi: 10.1016/j.cjca.2017.03.021. Epub 2017 Mar 31.
Consensus regarding the management of massive pulmonary embolism (PE) and persistent shock after thrombolysis is lacking. A 30-year-old man collapsed with massive PE 3 days after an exploratory laparotomy for penetrating trauma, and he remained hypoxic and hypotensive despite thrombolytic therapy. Extracorporeal membrane oxygenation (ECMO) was instituted as a bridge to surgical embolectomy, and placement of a right ventricular assist device (RVAD) was used to facilitate separation from cardiopulmonary bypass. After 48 hours, the RVAD was removed, and the patient survived to discharge. ECMO and temporary RVAD to support surgical embolectomy are lifesaving therapeutic considerations.
对于大面积肺栓塞（PE）的管理以及溶栓后持续休克的处理，目前尚无共识。一名30岁男性在因穿透性创伤行剖腹探查术后3天，因大面积PE而晕倒，尽管接受了溶栓治疗，仍处于低氧和低血压状态。体外膜肺氧合（ECMO）作为手术取栓的桥梁被启用，同时使用右心室辅助装置（RVAD）以促进脱离体外循环。48小时后，移除RVAD，患者存活并出院。ECMO和临时RVAD支持手术取栓是挽救生命的治疗考量。
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