慢性肺动脉栓塞血栓内膜剥脱术围手术期管理

Perioperative management of thromboendarterectomy for chronic pulmonary thromboemblism

目的 探讨慢性肺动脉血栓内膜剥脱术围手术期管理的方法。方法 总结 7例慢性肺动脉栓塞剥脱术 (PTE)病例的临床资料。结果 7例在体外循环下行肺动脉血栓内膜剥脱术 ,1例围术期死亡 ,6例存活。术后 2周测不吸氧状态下动脉血氧分压、血氧饱和度均有显著改善 (P<0 .0 5 ) ,术后 2周超声心动测肺动脉收缩压显著降低 (P <0 .0 5 ) ,生活质量明显改善。结论 术前术后积极降低肺动脉高压、纠正心功能不全 ,术后防治肺水肿及再栓塞的形成是肺动脉血栓内膜剥脱术围手术期管理的关键。

Objective To report the experience in perioperative management of chronic pulmonary thromboendoarterectomy(PTE).Methods A study regarding to perioperative management of thromboendoarterectomy for chronic pulmonary thromboemoblism was made in 7 patients.Results The PTE under cardiopulmonary bypass was performed in 7 patients.One patient died of pulmonary re-embolism postoperatively after operation,there was a marked increase of PaO 2 and SaO 2(P<0.05),and systolic pulmonary pressure(SPAP) decreased significantly (P<0.05) at the second postoperative week,with significant improvement in quality of life.Conclusion The key management for PTE is important for actively decreasing pulmonary hypertension,correcting heart dysfunction,and preventing perioperative pulmonary edema and re-thromboembolism.