Reperfusion pulmonary edema after pulmonary artery thromboendarterectomy.
Reperfusion pulmonary edema after pulmonary artery thromboendarterectomy.
复制标题
肺动脉血栓内膜切除术后再灌注肺水肿。
DOI：
10.1164/arrd.1986.134.6.1241
复制
发表时间：
1986
期刊：
影响因子：
--
通讯作者：
Moser,KM
中科院分区：
文献类型：
--
作者：
Levinson,RM;Shure,D;Moser,KM
肺动脉血栓内膜剥脱术（PAT）是一种治疗慢性、大血管血栓栓塞性肺动脉高压的潜在方法。然而，术后再灌注肺水肿（RPE）是一种严重的并发症，通常需要长时间的机械通气。这个实体在过去只被描述为轶事。为了更全面地描述它，我们回顾性分析了1969年至1984年在我们机构接受血栓动脉内膜切除术的22例PAT患者的病程和潜在的决定因素。特别关注临床数据、血栓位置、手术区域、术后X线片以及术前和术后血流动力学数据。除1例外，所有患者均在术后72小时内发生RPE，对应于PAT血管远端的解剖位置。在手术中未再灌注的肺区域均被保留。术前和术后肺毛细血管楔压和/或左心房压未升高。没有术前数据预测哪些患者会发生更持久的RPE。这些观察结果表明，RPE现象是一种特殊的局灶性肺水肿形式，其基础仍有待确定。
Pulmonary artery thromboendarterectomy (PAT) is a potentially curative procedure in chronic, major vessel thromboembolic pulmonary hypertension. However, postoperative reperfusion pulmonary edema (RPE) has been a serious complication, often requiring prolonged mechanical ventilation. This entity has been described only anecdotally in the past. To characterize it more fully, we retrospectively analyzed the course and potential determinants of RPE after thromboendarterectomy in 22 patients who had PAT at our institution from 1969 through 1984. Particular attention was directed to clinical data, thrombus location, areas operated, postoperative roentgenograms, and preoperative and postoperative hemodynamic data. In all patients but 1, RPE developed within 72 h after surgery, corresponding to anatomic locations distal to vessels subjected to PAT. Regions of lung not reperfused at surgery were uniformly spared. Pulmonary capillary wedge and/or left atrial pressures preoperatively and postoperatively were not elevated. None of the preoperative data predicted which patients would develop more persistent RPE. These observations suggest that the phenomenon of RPE is a peculiar, focal form of pulmonary edema, the basis for which remains to be defined.