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-  2016 

多科协作成功抢救术中致死性肺动脉栓塞的经验及体会(附两例报告)

DOI: doi:10.7507/1671-6205.2016095

Keywords: 肺动脉栓塞, 介入溶栓术, 多学科, 协作, 及时诊治

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Abstract:

目的总结术中急性致死性肺动脉栓塞的抢救经验,提高其早期诊断率和抢救成功率。 方法回顾分析2014年3月和2015年7月2例术中突发急性致死性肺动脉栓塞患者的临床资料。术中在麻醉科和胸心外科等科室密切配合下急诊行肺动脉介入碎栓溶栓术,术后观察生命征、Miller指数、平均肺动脉压(mPAP)与动脉血氧饱和度(SaO2)的变化,以及肺动脉开通情况和并发症。 结果术中经麻醉科、血管外科和胸心外科等科室的密切协作,2例患者均成功救治。术后患者血氧、心率、血压、呼吸等生命征明显改善,造影显示肺动脉明显开通,Miller指数从0.49±0.03降至0.25±0.05,SaO2从(45±5)mm Hg上升到(80±6)mm Hg,治疗前后差异有统计学意义(P<0.05)。术后均给予下腔静脉滤器安置及持续抗凝、抗血小板聚集等治疗,分别随访18个月和3个月,疗效持续,未见并发症和复发。 结论术中急性致死性肺栓塞病情危急,需加强及时诊断意识,需相关科室的通力协作,并迅速给予肺动脉介入溶栓治疗,能立即开通肺循环梗阻,降低肺动脉压,迅速改善心、肺血流动力学状态,疗效快速显著,值得临床推广

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