Mullerworth M H, Angelopoulos P, Couyant M A, Horton A M, Robinson S M, Petring O U, Mitchell P J, Presneill J J
Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Australia.
Ann Thorac Surg. 1998 Oct;66(4):1242-5. doi: 10.1016/s0003-4975(98)00593-1.
Catheter-induced pulmonary artery rupture is a well-recognized complication of invasive monitoring, but the risk has not diminished. Although commonly associated with cardiopulmonary bypass, injuries also occur in intensive care. Definitive proof requires pulmonary angiography or autopsy. Many cases are never reported, and lesser injuries are probably under-diagnosed.
Seven cases fulfilling accepted diagnostic criteria discovered over 2 years are described in four groups illustrating the common modes of presentation: hemoptysis with hypoxemia, exsanguination, delayed recurrent hemorrhage, and bleeding with cardiopulmonary bypass.
One patient had a planned elective operation deferred. Four patients were being monitored in intensive care. Two of them died of pulmonary artery rupture. Two other patients had bleeding on weaning from cardiopulmonary bypass. One settled with conservative treatment, the other survived after extracorporeal life support. Recognition and management are discussed, emphasizing means of avoiding pulmonary resection.
Catheter-induced pulmonary artery rupture is unavoidable. Constant awareness is essential. A plan of management is presented. Extracorporeal life support may help to avoid pulmonary resection. Early pulmonary angiography is advocated for accurate diagnosis and to enable treatment by embolization.
导管诱发的肺动脉破裂是一种公认的有创监测并发症，但风险并未降低。虽然该并发症通常与体外循环有关，但在重症监护中也会发生。确诊需要进行肺动脉造影或尸检。许多病例从未被报道，较轻的损伤可能未被充分诊断。
描述了在2年多时间里发现的7例符合公认诊断标准的病例，分为四组，展示了常见的表现形式：咯血伴低氧血症、大出血、延迟性反复出血以及体外循环时出血。
1例患者择期手术延期。4例患者在重症监护室接受监测。其中2例死于肺动脉破裂。另外2例患者在体外循环撤机时出血。1例经保守治疗好转，另1例在接受体外生命支持后存活。文中讨论了识别和处理方法，强调了避免肺切除的手段。
导管诱发的肺动脉破裂难以避免。持续保持警惕至关重要。本文提出了一个处理方案。体外生命支持可能有助于避免肺切除。提倡早期进行肺动脉造影以准确诊断并实现栓塞治疗。
