Key result
Non-heparinized extracorporeal life support successfully secured hemostasis within 12 hours and salvaged a patient with massive lung hemorrhage after pulmonary thromboembolectomy.
Case Report (n=1)
No
Non-heparinized extracorporeal life support can be an effective salvage therapy for life-threatening massive lung hemorrhage due to reperfusion injury following pulmonary thromboembolectomy.
May salvage refractory post-thromboembolectomy hemorrhage; hypothesis-generating and requires prospective confirmation before practice change.
肺血栓塞栓摘除術後の大量肺出血に対してnon-heparinized extracorporeal life supportを使用して救命しえた1例を経験した.症例は63歳,女性.胃全摘術後から数週間にわたって,徐々に呼吸困難感が増悪した.胸部CTおよび心臓超音波検査で右房内浮遊血栓を伴った亜急性の中枢型肺動脈血栓塞栓症と診断され,体外循環下に血栓摘除術を行った.肺血流再開後間もなく,再灌流性肺障害によると考えられる大量の肺出血を生じ,ヘパリンを含めた抗凝固非使用下でのextracorporeal life supportの維持を行った.術後12時間で肺出血は幸い鎮静化し,術後20時間でextracorporeal life supportから,48時間で人工呼吸器から離脱しえた.残存する下肢静脈血栓に対して下大静脈フィルターを留置したのち退院した.Non-heparinized extracorporeal life supportの功罪については慎重な議論を要するが,本法は肺再灌流障害による致死的肺出血に対して,救命のために考慮されるべき手法であると考えられた.
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宗明 et al. (2004) conducted a case report in Massive lung hemorrhage after pulmonary thromboembolectomy (n=1). Non-heparinized extracorporeal life support was evaluated on Hemostasis and survival. Non-heparinized extracorporeal life support successfully secured hemostasis within 12 hours and salvaged a patient with massive lung hemorrhage after pulmonary thromboembolectomy.
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