摘要
目的探讨急性肺动脉栓塞致难治性心跳骤停的临床特点及救治措施,提高对肺动脉栓塞的认识及处理能力。方法回顾性分析2017年3月至2019年3月解放军联勤保障部队第九○九医院收治的12例肺动脉栓塞致难治性心跳骤停患者的临床资料,其中男9例,女3例,年龄48~76岁,平均(62.8±8.9)岁。统计分析患者临床表现、实验室检查、救治措施及并发症情况。结果5例患者经传统心肺复苏(CCPR)后恢复自主功能,1例患者经体外心肺复苏(ECPR)后恢复自主功能,3例患者经心肺复苏后脑缺血缺氧时间长呈植物生存状态,3例患者经多次心肺复苏后出现“死亡三联征”死亡。9例复苏成功患者中4例出现泌尿系统出血,经膀胱冲洗保持导尿管引流通畅治愈;7例出现急性肾功能损害,经连续性血液净化治疗后,肾功能均恢复正常;8例出现不同程度的消化道出血,经禁食、持续胃肠减压、输血、抑制胃酸分泌治疗后均治愈。9例复苏成功均获得随访,3例植物状态患者分别在血栓发病后第55、86、242天死于呼吸衰竭;6例患者随访6个月~2年,随访期内均存活。结论加强对肺动脉栓塞致难治性心跳骤停的认识,采取及时、有效的溶栓、心肺复苏及各系统器官维护,可提高救治效率。
Objective To explore the clinical characteristics and treatment measures of pulmonary embolism(PE)induced refractory cardiac arrest,so as to increase the understanding and treatment ability of PE.Methods The clinical data of 12 patients with refractory cardiac arrest caused by pulmonary embolism in our hospital from March 2017 to March 2019 were analyzed retrospectively,including 9 males and 3 females,aged 48-76 years,with an average age of(62.8±8.9)years.The clinical manifestations,laboratory examination,treatment measures and complications of 12 patients were analysed.Results Five patients recovered autonomic function after conventional cardiopulmonary resuscitation(CCPR),and one patient recovered autonomic function after extracorporeal cardiopulmonary resuscitation(ECPR),three patients suffered from long-term vegetative state of cerebral ischemia and hypoxia after CCPR,and three patients died of"death triad"after CCPR for many time.In 9 cases of successful resuscitation,4 cases had urinary system bleeding,which was cured by keeping catheter drainage unobstructed after bladder washing,7 cases had acute renal function damage,after continuous blood purification treatment,renal function was restored to normal,8 cases had different degrees of gastrointestinal bleeding,which was cured b y fasting,continuous gastrointestinal decompression,blood transfusion and inhibition of gastric acid secretion.All the 9 patients were monitored.Three patients with vegetative state died of respiratory failure on the 55th,86th and 242nd day after thrombosis.Six patients were followed up for 6 months to 2 years,all of them survived in the follow-up period.Conclusion To enhance the understanding of pulmonary embolism induced refractory cardiac arrest,to take timely and effective thrombolysis,cardiopulmonary resuscitation and maintenance of various system organs can improve the treatment efficiency.
作者
何宁
刘胜利
窦燕
HE Ning;LIU Sheng-li;DOU Yan(Department of Critical Medicine,the 909th Hospital of the Joint Logistics Support Force,PLA,Zhangzhou 363000,Fujian,China;Department of Burn and Plastic Surgery,the 909th Hospital of the Joint Logistics Support Force,PLA,Zhangzhou 363000,Fujian,China)
出处
《东南国防医药》
2021年第2期136-140,共5页
Military Medical Journal of Southeast China
基金
漳州市科技拥军项目(ZZ2019KD02)。
关键词
肺动脉栓塞
难治性心跳骤停
心肺复苏
pulmonary embolism
refractory cardiac arrest
cardiopulmonary resuscitation
