床旁超声辅助诊断围手术期急性肺栓塞4例临床分析  

Point-of-care ultrasound in the auxiliary diagnosis of perioperative acute pulmonary embolism in four cases

作　　者：程怡 袁玉静 高颖[1] 薛富善 CHENG Yi;YUAN Yujing;GAO Ying;XUE Fushan(Anesthesiology and Operation Center,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Anesthesiology Medical Center,Fujian Provincial Hospital Af filiated to Fuzhou University,Fuzhou,Fujian 350001,China)

机构地区：[1]首都医科大学附属北京友谊医院麻醉手术中心,北京100050 [2]福州大学附属省立医院麻醉医学中心,福建福州350001

出　　处：《中华实用诊断与治疗杂志》2025年第1期32-37,共6页Journal of Chinese Practical Diagnosis and Therapy

摘　　要：目的 探讨床旁超声(POCUS)对围手术期急性肺栓塞(APE)的诊断价值及在调整治疗方案和评估预后中的意义。方法 2021年8月—2024年2月首都医科大学附属北京友谊医院围手术期发生急性肺栓塞4例。例1、例2、例3均于术中突发血流动力学障碍,应用POCUS根据心腔内游动气体、右心室大小和室间隔位置辅助诊断为APE,给予针对性治疗措施,及时调整手术方案。例4为巨大卵巢肿瘤破裂感染的急诊限期手术患者,术前突发APE,在POCUS动态监测下行择期开腹手术,术中突发呼吸循环波动,POCUS辅助诊断为肺栓塞加重,根据POCUS监测结果调整液体量和血管活性药物。结果 4例均根据POCSU监测结果、生命体征变化及手术紧迫性个体化调整手术方案,例1和例3暂停手术,例2和例4于POCUS监测下顺利完成手术。4例均未发生APE相关并发症,预后良好。结论 POCUS通过探查心腔内游动气体、右心室大小和室间隔位置为围手术期APE的诊断及判断肺栓塞的原因和栓子性质提供参考,有助于及时调整治疗方案和评估预后。Objective To investigate the value of point-of-care ultrasound(POCUS) to the diagnosis of perioperative acute pulmonary embolism(APE) and its significance in adjusting the therapy plan and evaluating the prognosis.Methods Four patients with perioperative APE were treated in Beijing Friendship Hospital of Capital Medical University from August 2021 to February 2024.Sudden hemodynamic disturbances occurred in patient 1-3 during the surgery.POCUS was applied to assist the diagnosis of APE by determining the wandering gas in the heart cavity,the size of the right ventricle,and the location of the interventricular septum.Targeted therapy measures were administered,and the surgical plans were adjusted in time.Patient 4,with ruptured and infected huge ovarian tumor who was scheduled for emergency limited surgery,developed APE suddenly before surgery,and was performed an elective laparotomy under POCUS dynamic monitoring.Sudden respiratory and circulatory fluctuations occurred during surgery.POCUS was applied to assist the diagnosis of aggravated APE.Infusion volume and vasoactive drugs were adjusted based on the POCUS monitoring results.Results Based on the results of POCUS monitoring,changes in vital signs and urgency of surgery,the individualized surgical plan was adjusted in four patients.The surgery was temporarily suspended in patient 1 and 3,and the surgery was successfully completed in patient 2 and 4 under POCUS monitoring.No APE-related complications occurred in four patients,and their prognoses were good.Conclusion POCUS can provide reference for the diagnosis of perioperative APE and the determination of the cause and embolus character of pulmonary embolism by probing the wandering gas in the heart cavity,the size of the right ventricle and the location of the interventricular septum,and help to adjust the therapy in time and evaluate the prognosis.

关 键 词：急性肺栓塞 围手术期 床旁超声 

分 类 号：R563.5[医药卫生—呼吸系统] R619[医药卫生—内科学]