背景:术中肺栓塞(PE)伴心脏骤停(CA)是一种危重且可能致命的疾病。可用的治疗方法包括全身溶栓,基于导管的血栓碎裂或抽吸,和外科取栓术.然而,有限的研究集中在这种危重情况的最佳治疗选择上.我们介绍了一系列病例,并对PE继发术中CA的管理进行了更新。
方法:对2012年6月至2022年6月期间发生术中高危PE的患者进行了回顾性回顾。对于更新的审查,在PubMed和Scopus上进行了文献检索,共纳入46篇文章.
结果:在2012年至2022年期间,共进行了196-174次大型非心脏手术。确定了8例术中继发于高危PE的CA。我们发现死亡率为75%。一名患者接受了抗凝治疗(12.5%),而两名患者(25%)接受了溶栓治疗,1例(12.5%)行机械取栓联合血栓抽吸术。根据文献回顾和我们10年的经验,我们提出了一种算法来处理由PE引起的术中CA。
结论:术中采用CA充分管理PE的重要组成部分包括血流动力学支持,心肺复苏,并实施一次灌注干预。迅速确定每种特定治疗方式的标准,以个体患者的特征为指导,是最优方法所必需的。
Intraoperative pulmonary embolism (PE) with cardiac arrest (CA) represents a critical and potentially fatal condition. Available treatments include systemic thrombolysis, catheter-based thrombus fragmentation or aspiration, and surgical embolectomy. However, limited studies are focused on the optimal treatment choice for this critical condition. We present a
case series and an updated review of the management of intraoperative CA secondary to PE.
A retrospective review of patients who developed high-risk intraoperative PE was performed between June 2012 and June 2022. For the updated review, a literature search on PubMed and Scopus was conducted which resulted in the inclusion of a total of 46 articles.
A total of 196 174 major non-cardiac surgeries were performed between 2012 and 2022. Eight cases of intraoperative CA secondary to high-risk PE were identified. We found a mortality rate of 75%. Anticoagulation therapy was administered to one patient (12.5%), while two patients (25%) underwent thrombolysis, and one
case (12.5%) underwent mechanical thrombectomy combined with thrombus aspiration. Based on the literature review and our 10-year experience, we propose an algorithm for the management of intraoperative CA caused by PE.
The essential components for adequate management of intraoperative PE with CA include hemodynamic support, cardiopulmonary resuscitation, and the implementation of a primary perfusion intervention. The prompt identification of the criteria for each specific treatment modality, guided by the individual patient\'s characteristics, is necessary for an optimal approach.