肺动脉血栓内膜剥脱术的围手术期处理  

Perioperative management of thromboendarterectomy for chronic pulmonary thromboemblism

作　　者：张超纪[1] 任华[1] 苏丕雄[2] 王辰[3] 朱晓东[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院心外科,100730 [2]首都医科大学附属北京朝阳医院心外科 [3]首都医科大学附属北京朝阳医院北京呼吸病研究所

出　　处：《北京医学》2003年第4期267-269,共3页Beijing Medical Journal

基　　金："十五"国家科技攻关资助项目 ( 2 0 0 1BA70 3B13 )

摘　　要：目的　探讨肺动脉栓塞围手术期的处理方法。方法　总结 8例肺动脉血栓内膜剥脱术 (PTE)患者的临床资料及近中期结果。结果　 7例在体外循环下行肺动脉血栓内膜剥脱术 ,1例在非体外循环下手术。 1例围手术期死亡 ,7例存活。术后 2周测不吸氧状态下动脉血氧分压、血氧饱和度 ,均有显著改善 (P <0 .0 5 ) ,术后 2周超声心动测肺动脉收缩压显著降低 (P <0 .0 5 ) ,术后随访 1～ 2 4个月 ,心功能提高到NYHAⅠ级 4例 ,Ⅱ级 3例 ,生活质量明显改善。结论　术前术后积极降低肺动脉高压、纠正心功能不全 。Objective To report the experience in perioperative management of chronic pulmonary thromboendoarterectomy.Methods A retrospective study regarding to perioperative management of thromboendoarterectomy for chronic pulmonary thromboemoblism was made in 8 patients.Results 7 patients underwent PTE with a median sternotomy under cardiopulmonary bypass and 1 case received PTE procedure through left posterior lateral thoracotomy without cardiopulmonary bypass.One patient died of pulmonary re-embolism postoperatively. There was a marked increase of PaO 2 and SaO 2( P <0.05) and systolic pulmonary pressure(SPAP) decreased significantly ( P <0.05) at the second postoperative week.Mid term follow up showed that the cardiac function of the patients came to NYHA class Ⅰ(n=4)and Ⅱ(n=3),with significant improvement in quality of life.Conclusions The key management after pulmonary thromboendoarterectomy is important to descrease pulmonary hypertension,to correct heart failure,and to prevent perioperative pulmonary edema and re thromboembolism.

关 键 词：肺动脉血栓内膜剥脱术 围手术期 处理 肺血栓栓塞 肺动脉高压 

分 类 号：R654.3[医药卫生—外科学]