Mattox K L, Feldtman R W, Beall A C, DeBakey M E
Ann Surg. 1982 Jun;195(6):726-31. doi: 10.1097/00000658-198206000-00008.
During the period from 1961 to 1981, 40 pulmonary embolectomies were performed in 39 patients who were in extremis at the time of initiation of cardiopulmonary bypass. In a 460-bed hospital with more than 17,000 acute admissions and 4,000 operations per year, this small number represents the few patients who are potentially salvageable by urgent embolectomy. Preoperative angiography was performed in 57% of the cases, and in another ten patients suspected of having pulmonary emboli, angiography prevented unnecessary thoracotomy. Despite their moribund condition, 43% of the embolectomy patients lived. Excluding two patients with tumor occlusion of the pulmonary arteries and three patients with chronic cor pulmonale from old pulmonary emboli, the survival rate was 50%. Ten patients died because of hypoxemia and hypotension prior to initiation of cardiopulmonary bypass, and seven died of myocardial depression of multiple etiologies. Portable cardiopulmonary bypass affords the possibility of survival in moribund patients with acute massive pulmonary embolism. Preoperative angiography is recommended to guide appropriate surgical management.
在1961年至1981年期间，对39例在开始体外循环时处于濒死状态的患者实施了40例肺动脉栓子切除术。在一家拥有460张床位、每年急性入院患者超过17000例且手术量达4000例的医院中，这一较小的数量代表了那些有可能通过紧急栓子切除术挽救的少数患者。57%的病例进行了术前血管造影，另外10例疑似患有肺栓塞的患者，血管造影避免了不必要的开胸手术。尽管病情垂危，但43%的栓子切除术患者存活了下来。排除2例因肿瘤阻塞肺动脉的患者以及3例因陈旧性肺栓塞导致慢性肺源性心脏病的患者，存活率为50%。10例患者在开始体外循环前因低氧血症和低血压死亡，7例死于多种病因导致的心肌抑制。便携式体外循环为急性大面积肺栓塞的濒死患者提供了生存的可能性。建议进行术前血管造影以指导适当的手术治疗。
