成人法洛三联症矫正术后并发急性肺栓塞一例并文献复习  

Acute Pulmonary Embolism after Correction of Trilogy of Fallot in Adults: A Case Report and Literature Review

作　　者：傅建军 许国安[1] 周亚军[1] 徐靖[1] FU Jianjun;XU Guo-an;ZHOU Yajun;XU Jing(Department of Cardiothoracic Surgery,the Chinese PLA 94th Hospital,Nanchang 330002,China)

机构地区：[1]解放军第九四医院心胸外科,南昌330002

出　　处：《医学综述》2018年第4期827-832,共6页Medical Recapitulate

摘　　要：目的分析法洛三联症矫正术后急性肺栓塞患者的临床资料,探讨该病的临床特点与诊断治疗。方法回顾性分析2017年5月解放军第九四医院心胸外科收治的1例成人法洛三联症矫正术后第5天发生急性肺栓塞患者的临床特点、治疗方法,并结合相关文献进行复习讨论。结果患者术后第5天突发胸前疼痛,进行性加重,呼吸心率增快,血压指脉氧进行性降低,立即查动脉血气分析、床边X线胸片、床边心电图辅助诊断,呼吸机辅助呼吸,前列地尔改善微循环等治疗,症状缓解后查CT肺动脉造影示右下肺基底干动脉栓塞,明确诊断后予强心利尿稳定心功能、抗凝、改善微循环、脏器支持等对症处理后最终痊愈出院。结论成人法洛三联症作为一类发绀型心脏病术后发生肺栓塞危险因素多,其临床表现与原有心脏疾病有较多共同点,易漏诊、误诊,快速明确诊断及早期对症治疗是提高患者生存率及预后的有效手段。Objective To analyze the clinical data of patients with surgical correction of Trilogy of Fallot after acute pulmonary embolism(PE),to investigate the clinical characteristics and the diagnosis and treatment of the disease.Methods Retrospective analysis on one adult patient with Trilogy of Fallot from department of cardiothoracic surgery the Chinese PLA 94th Hospital in May 2017 with occurrence of acute PE 5 days after surgery was done,the clinical characteristics,treatment and related literature were analyzed and discussed.Results On fifth days after surgery the patient bursted progressively aggravating outchest pain,breath and heart rate acclerating,progressive blood pressure,pulse oxygen decreasing,immediate check of the arterial blood gas,bedside chest X-ray,bedside electrocardiogram,ventilator assisted breathing,alprostadil treatment were given to improve microcirculation and relieve symptoms.Pulmonary artery CT revealed right infe-rior pulmonary basilar artery embolism.After clear diagnosis to stabilize cardiac function,cardiac diuretics,anticoagulation,microcirculation improving and organ support were given as symptomatic treatment which lead to complete recovery and discharge from hospital.Conclusion Adult Trilogy of Fallot as a kind of cyanotic heart disease has multiple risk factors of postoperative PE,and the clinical manifestations have more in common with the original heart disease,which may be easily misdiagnosed and missed diagnosed,therefore rapid diagnosis and early treatment is an effective way to improve the survival rate and prognosis of the patients.

关 键 词：法洛三联症 肺栓塞 抢救 

分 类 号：R619.2[医药卫生—外科学]