急性重症肺栓塞外科治疗八例

Surgical embolectomy of acute massive pulmonary embolism in 8 cases

目的总结手术肺动脉取栓治疗急性重症肺栓塞的临床特点。方法2016年1月~2019年10月收治的急性重症肺栓塞病人8例,均采用体外循环下肺动脉取栓治疗,近期行颅内手术2例,肺栓塞同时合并下腔静脉血栓病人1例,术前行心肺复苏2例,其中1例行体外膜肺(ECMO)支持。结果8例手术成功,所有病人术后肺动脉压力明显降低[(39.8±6.1)mmHg vs.(18.0±5.4)mmHg,P<0.05];围手术期因肺部感染死亡1例,治愈出院7例,病人术后随访(35.7±14.1)个月,无肺栓塞复发。结论手术肺动脉取栓治疗急性重症肺动脉栓塞近中期效果良好,体外膜肺支持是提高救治成功率的有效手段,及时手术是成功救治的关键。

Objective To investigate the clinical characteristics of surgical embolectomy in the treatment of acute massive pulmonary embolism(AMPE).Methods From January 2016 to October 2019,8 patients with AMPE were treated with surgical embolectomy under cardiopulmonary bypass(CPB).Two patients underwent intracranial surgery recently;one patient with pulmonary embolism complicated with inferior vena cava thrombosis;two patients underwent cardiopulmonary resuscitation before surgery,including one case with extracorporeal membrane lung(ECMO)support.Results The success rate of the operation was 100%.The pulmonary artery pressure of all patients decreased significantly[(39.8±6.1)mmHg vs.(18.0±5.4)mmHg,P<0.05].One patient died during perioperative period(1/8,12.5%),and 7 patients(7/8,87.5%)were cured.All patients were followed up for(35.7±14.1)months without pulmonary embolism.Conclusion Surgical embolectomy is feasible for the treatment of acute massive pulmonary embolism,extracorporeal lift support is an effective means to improve the success rate of treatment,and the timeliness of operation is the key to successful treatment.