Urschel J D, Myerowitz P D
Department of Surgery, University of Alberta, Edmonton, Canada.
Ann Thorac Surg. 1993 Sep;56(3):585-9. doi: 10.1016/0003-4975(93)90912-2.
Pulmonary artery rupture is an infrequent complication of flow-directed catheters. Because cardiopulmonary bypass offers an opportunity for control of gas exchange and hemorrhage, pulmonary artery rupture in this setting is different from that occurring in the intensive care unit and catheterization laboratory. A collective review of 30 published cases was conducted. Sixty-nine percent of patients were female and 50% had valvular heart disease. The right pulmonary artery was injured in 93% of cases. Arterial rupture presented with airway hemorrhage in 29 of 30 patients. Six patients presented with a herald airway bleed after catheter insertion but before operation. Three of 4 patients died when operation was performed in the face of a herald bleed. Airway hemorrhage most commonly developed during bypass weaning (19 cases). Recurrent hemorrhage occurred in 45% of patients (9/20) treated conservatively compared with 0% (0/7) in those having surgical control of bleeding (p = 0.07). Three patients died in the operating room. Overall mortality was 41%. Uncontrolled hemorrhage was the leading cause of death. Conservative management strategies are associated with a high incidence of secondary, often fatal, hemorrhage. Although pulmonary resection controls bleeding, mortality from other causes is a problem. A treatment protocol is proposed that considers these management dilemmas.
肺动脉破裂是血流导向导管的一种罕见并发症。由于体外循环为控制气体交换和出血提供了机会，这种情况下的肺动脉破裂与重症监护病房和心导管室中发生的情况不同。对已发表的30例病例进行了综合回顾。69%的患者为女性，50%患有瓣膜性心脏病。93%的病例右肺动脉受损。30例患者中有29例动脉破裂表现为气道出血。6例患者在导管插入后但手术前出现先兆气道出血。4例患者中有3例在出现先兆出血后进行手术时死亡。气道出血最常见于体外循环撤机期间（19例）。保守治疗的患者中45%（9/20）发生反复出血，而手术控制出血的患者中这一比例为0%（0/7）（p = 0.07）。3例患者在手术室死亡。总体死亡率为41%。出血无法控制是主要死因。保守治疗策略与继发性、通常致命的出血高发生率相关。尽管肺切除术可控制出血，但其他原因导致的死亡率仍是一个问题。提出了一种考虑这些治疗困境的治疗方案。
