肺动脉血栓内膜剥脱术的围手术期处理  

Perioperative Treatments of Pulmonary Thromb-Endarterectomy

作　　者：吴永波[1] 吴清玉[1] 郭少先[1] 崔光浩 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院心外科,北京市100037

出　　处：《中国循环杂志》2000年第5期300-301,共2页Chinese Circulation Journal

摘　　要：目的 :报告肺动脉血栓内膜剥脱术 (PTE)的围手术期处理经验。　　方法 :总结连续 6例 PTE的围手术期处理方法 ,术后机械辅助通气 ,在维持循环稳定的情况下加强利尿 ,静脉滴注硝酸甘油或前列腺素 E维持肺动脉压 ,给予多巴胺或多巴酚丁胺辅助心功能。　　结果 :6例患者术后均存活 ,术后 2周时均无肺水肿征像及肺动脉高压 ;其平均肺动脉压力为 3.6± 1.1k Pa(1k Pa=7.5 mm Hg) ,动脉血氧分压为 12 .1± 0 .6 k Pa。术后平均随访 17.3个月 ,肺动脉栓塞症状消失。　　结论 :PTE围手术期处理的关键是防治肺动脉高压和血栓剥离后肺再灌注引起的肺水肿。前者的防治给血管扩张剂充分镇静 ,后者的防治则为机械辅助通气和加强利尿。Objective:To report experience in perioperative treatment of pulmonary thromb endarterectomy (PTE). Methods:Six cases of pulmonary thromb endarterectomy preformed in Fu Wai hospital were reviewed.Perioprative treatment was emphasized. Results:All 6 patients survived the operation.Two weeks after PTE,no pulmonary edema and pulmonary hypertension were found,with mean pulmonary pressure at 3 6±1 1 kPa (1 kPa=7 5 mmHg) and pressure of artery oxygen at 12 1±0 6 kPa.Follow up studies (mean 17 3 months post PTE) found all patients to be in NYHA class I without any symptoms. Conclusion:Proper treatment to pulmonary hypertension and pulmonary edema caused by reperfusion after PTE is key to successful PTE.Enough sedation and use of vasodilators are effective in treatment of pulmonary hypertension;and mechanical ventilation and use of diuretics,to pulmonary edema.

关 键 词：肺动脉栓塞 血栓内膜剥脱术 围手术期处理 

分 类 号：R563.5[医药卫生—呼吸系统] R654[医药卫生—内科学]