-327久留米大学医学部麻酔学講座(〒830-0011 福岡県久留米市旭町67) 受付日2007年 8 月 3 日 採択日2008年 1 月14日 要約:患者は59歳,男性。交通外傷による骨盤骨折で10日間の骨盤牽引後,骨接合術が予定 された。術中動脈損傷による大量出血を来し,その直後に低血圧と呼気終末二酸化炭素濃度 (end-tidal carbon dioxide, EtCO2)の低下を認め,同時にSpO2の低下を来した。動脈血ガス分 析でEtCO2とPaCO2の解離および経食道心臓超音波検査で右心負荷所見を認めたため急性肺 塞栓症を最も疑った。血栓溶解療法を施行したが効果は認められず,継続する低酸素血症と 不安定な循環動態のため,経皮的心肺補助装置(percutaneous cardiopulmonary support, PCPS)を導入した。PCPS装着後も呼吸循環動態が改善しなかったため,人工心肺を用いた肺 動脈内血栓摘除術を施行した。その後順調に回復し,3日目にPCPSを離脱した。術後のリハ ビリテーションの際,残存する深部静脈血栓による肺塞栓症再発予防のために回収式下大静 脈フィルターを留置した。その後,下大静脈フィルターを抜去し70日後に後遺症なく退院した。 時機を逸しない早期のPCPSの導入と肺動脈内血栓摘除術が重症肺塞栓症の患者には必要であ ると考えられた。

A case of massive pulmonary embolism during pelvic surgery

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A case of massive pulmonary embolism during pelvic surgery