Ohteki H, Norita H, Sakai M, Narita Y
Department of Cardiovascular Surgery, Saga Prefecture Hospital Koseikan, Saga City, Japan.
Ann Thorac Surg. 1997 Jun;63(6):1584-6. doi: 10.1016/s0003-4975(97)00212-9.
The management of patients with acute pulmonary embolism remains difficult, particularly when cardiogenic shock is involved. The preoperative incidence of cardiac arrest compromises the results of emergency pulmonary embolectomy. In an attempt to reduce the operative mortality rate, we applied percutaneous cardiopulmonary bypass support to restore vital organ perfusion before the surgical intervention.
Percutaneous cardiopulmonary bypass support was preoperatively instituted in 3 patients with acute cardiopulmonary collapse caused by massive pulmonary embolism. In each patient, cardiac massage and endotracheal intubation were necessary due to loss of consciousness, hypotension, and severe cyanosis. Transesophageal echocardiography was performed to detect any evidence of thrombus in the main pulmonary artery, and each patient underwent the emergency pulmonary embolectomy using conventional cardiopulmonary bypass through a median sternotomy.
Percutaneous cardiopulmonary bypass support immediately provided effective cardiopulmonary resuscitation. Transesophageal echocardiography clearly demonstrated any evidence of thrombus located in the pulmonary artery. Each patient was discharged from the hospital without any postoperative complication.
The use of percutaneous cardiopulmonary bypass support immediately resuscitated and stabilized the cardiopulmonary function and allowed for successful emergency pulmonary embolectomy. In each patient, transesophageal echocardiography was useful for prompt and noninvasive diagnosis.
急性肺栓塞患者的治疗仍然具有挑战性，尤其是合并心源性休克时。术前心脏骤停的发生率会影响急诊肺血栓切除术的结果。为了降低手术死亡率，我们在手术干预前应用经皮心肺转流支持以恢复重要器官灌注。
对3例因大面积肺栓塞导致急性心肺功能衰竭的患者术前实施经皮心肺转流支持。由于意识丧失、低血压和严重发绀，每位患者均需要进行心脏按压和气管插管。行经食管超声心动图检查以检测主肺动脉内血栓的证据，每位患者均通过正中胸骨切开术采用传统心肺转流进行急诊肺血栓切除术。
经皮心肺转流支持立即提供了有效的心肺复苏。经食管超声心动图清楚地显示了肺动脉内血栓的证据。每位患者均无术后并发症出院。
使用经皮心肺转流支持可立即复苏并稳定心肺功能，并使急诊肺血栓切除术成功进行。对每位患者而言，经食管超声心动图有助于快速无创诊断。
