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病例报告:在一名严重多发伤患者中,使用AngioJet血栓切除术并联合体外膜肺氧合支持治疗急性大面积肺栓塞

Case report: AngioJet thrombectomy with extracorporeal membrane oxygenation support for acute massive pulmonary embolism in a severe multiple trauma patient.

作者信息

Tian Lun, Zhang Libin, Zhang Naiding, Xu Xin, Xu Yongshan, Liu Zhenjie, Huang Man

机构信息

Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.

Department of Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.

出版信息

Front Med (Lausanne). 2022 Oct 14;9:989613. doi: 10.3389/fmed.2022.989613. eCollection 2022.

Abstract

Acute massive pulmonary embolism (PE) is one of the main leading causes of high cardiovascular mortality, and the prognosis strongly varies, depending on the severity of pulmonary arterial obstruction and its impact on the RV function. Alternative therapy approaches comprise systemic thrombolysis, catheter-directed thrombolysis, catheter embolectomy, catheter-assisted fragmentation techniques, and surgical thrombectomy. The following case study explores a 72-year-old man with severe multiple trauma who suffered from a sudden massive pulmonary embolism and presented with an unstable hemodynamic status. Extracorporeal membrane oxygenation (ECMO) has amply proven its efficacy in supplying cardiopulmonary assistance for this patient shocked by a massive PE with contraindication for thrombolysis. AngioJet catheter embolectomy and ECMO were performed, which finally cleared the massive pulmonary embolism away and improved the patient's hemodynamic status. The use of ECMO was continued during the weaning program, on the fifth day after ECMO decannulation, the patient was extubated and transferred to a local hospital for further recuperation. This case highlights that the AngioJet thrombectomy with the combination use of ECMO may be a potential choice of treatment for unstable PE patients.

摘要

急性大面积肺栓塞(PE)是心血管疾病高死亡率的主要原因之一,其预后差异很大,取决于肺动脉阻塞的严重程度及其对右心室功能的影响。替代治疗方法包括全身溶栓、导管定向溶栓、导管取栓术、导管辅助碎栓技术和外科血栓切除术。以下病例研究探讨了一名72岁的严重多发伤男性患者,他突然发生大面积肺栓塞并出现血流动力学不稳定状态。体外膜肺氧合(ECMO)已充分证明其在为因大面积PE而休克且有溶栓禁忌证的患者提供心肺支持方面的有效性。进行了AngioJet导管取栓术和ECMO治疗,最终清除了大面积肺栓塞并改善了患者的血流动力学状态。在撤机过程中继续使用ECMO,ECMO拔管后第5天,患者拔管并转至当地医院进一步康复。该病例表明,AngioJet血栓切除术联合ECMO可能是不稳定PE患者的一种潜在治疗选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9d75/9613946/b9905874fc79/fmed-09-989613-g0001.jpg

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