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脑动脉造影术后严重肺栓塞的警示:病例报告及文献复习。

Warning of severe pulmonary embolism after cerebral angiography: A case report and literature review.

机构信息

Department of Neurosurgery, The Ningbo Beilun District People's Hospital, Ningbo, China.

Department of Anesthesia, The Ningbo Beilun District People's Hospital, Ningbo, China.

出版信息

Medicine (Baltimore). 2024 Sep 27;103(39):e39635. doi: 10.1097/MD.0000000000039635.

DOI:10.1097/MD.0000000000039635
PMID:39331922
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11441969/
Abstract

RATIONALE

Acute pulmonary embolism (PE), which can lead to cardiac and respiratory arrest, is a rare complication of cerebral angiography. However, neurologists do not pay attention to this.

PATIENT CONCERNS

A 47-year-old male with a history of type 2 diabetes was admitted to our hospital for evaluation of surgical indications for unruptured ophthalmic aneurysms. After cerebral angiography, a fatal PE occurred. Through rapid identification and effective drug treatment, the patient recovered and was discharged.

DIAGNOSES

A diagnosis of fatal PE was made based on the bedside ultrasonography and blood d-dimer level.

INTERVENTIONS

Cardiopulmonary resuscitation and intravenous thrombolysis of "50 mg alteplase" for continuous intravenous drip for 2 hours.

OUTCOMES

The patient was recovered and no special discomfort was reported.

LESSONS

PE is a rare complication of cerebral angiography, but the fatality rate is very high. Neurologists must not only early identify and effectively treat this complication, but more importantly, pay attention to this complication, prevent it in advance, and reduce the occurrence of catastrophic events.

摘要

背景

急性肺栓塞(PE)可导致心搏和呼吸骤停,是脑血管造影术罕见的并发症。然而,神经科医生并未对此给予重视。

病例介绍

一名 47 岁男性,有 2 型糖尿病病史,因未破裂眼动脉瘤的手术适应证入我院。行脑血管造影术后发生致死性 PE。通过快速识别和有效的药物治疗,患者康复并出院。

诊断

根据床旁超声和血 D-二聚体水平诊断为致死性 PE。

干预措施

心肺复苏,给予“50mg 阿替普酶”静脉溶栓,持续静脉滴注 2 小时。

结果

患者康复,无特殊不适。

经验教训

PE 是脑血管造影术罕见的并发症,但病死率非常高。神经科医生不仅要早期识别和有效治疗这种并发症,更重要的是要重视这种并发症,预防其发生,减少灾难性事件的发生。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/895a/11441969/075df514e271/medi-103-e39635-g006.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/895a/11441969/cc10126b7553/medi-103-e39635-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/895a/11441969/43522bfae941/medi-103-e39635-g005.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/895a/11441969/e704184562e8/medi-103-e39635-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/895a/11441969/781e87e8c303/medi-103-e39635-g002.jpg
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本文引用的文献

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The Diagnostic Value of Bedside Echocardiography and Lower Extremity Blood Vessels in Acute Pulmonary Embolism.床旁超声心动图及下肢血管检查对急性肺栓塞的诊断价值
Stem Cells Int. 2022 Sep 28;2022:5012613. doi: 10.1155/2022/5012613. eCollection 2022.
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Acute Pulmonary Embolism: A Review.急性肺栓塞:综述。
JAMA. 2022 Oct 4;328(13):1336-1345. doi: 10.1001/jama.2022.16815.
3
Transradial versus transfemoral approach for cerebral angiography: A prospective comparison.经桡动脉与经股动脉途径行脑血管造影:一项前瞻性比较研究。
J Interv Med. 2019 Jun 27;2(1):31-34. doi: 10.1016/j.jimed.2019.05.008. eCollection 2019 Feb.
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Introduction for Focused Updates in Cerebrovascular Disease.脑血管疾病重点更新内容介绍。
Stroke. 2020 Mar;51(3):708-710. doi: 10.1161/STROKEAHA.119.024159. Epub 2020 Feb 12.
5
Acute Pulmonary Embolism: Imaging Techniques, Findings, Endovascular Treatment and Differential Diagnoses.急性肺栓塞:成像技术、表现、血管内治疗及鉴别诊断
Rofo. 2020 Jan;192(1):38-49. doi: 10.1055/a-0900-4200. Epub 2019 May 28.
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Imaging of acute pulmonary embolism: an update.急性肺栓塞的影像学检查:最新进展
Cardiovasc Diagn Ther. 2018 Jun;8(3):225-243. doi: 10.21037/cdt.2017.12.01.
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Cerebral catheter angiography and its complications.脑导管血管造影术及其并发症。
Pract Neurol. 2018 Oct;18(5):393-398. doi: 10.1136/practneurol-2018-001986. Epub 2018 Jul 18.
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Exclusion of deep vein thrombosis using the Wells rule in clinically important subgroups: individual patient data meta-analysis.在具有临床重要意义的亚组中使用Wells规则排除深静脉血栓形成:个体患者数据荟萃分析
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Aesthet Surg J. 2014 Jan 1;34(1):87-95. doi: 10.1177/1090820X13514077. Epub 2013 Dec 10.
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