緊急肺血栓摘除手術により救命し得た失神を伴う急性広範肺血栓塞栓症の1例

Life-saving emergency pulmonary thromboembolectomy in a case of acute massive pulmonary thromboembolism with syncope

　肺血栓塞栓症（pulmonary thromboembolism：PTE）は従来我が国では比較的まれとされていたが，食生活を中心とした生活様式の変化や診断技術の向上のためか，近年増加傾向にある^1）。急性肺血栓塞栓症（acute pul—monary thromboembolism：APTE）の中で肺動脈閉塞の程度がきわめて高度の場合，これを急性広範肺血栓塞栓症（acute massive PTE）というが，これはしばしば突然死の原因となっている。我々は急性広範肺血栓塞栓症に対し緊急肺血栓摘除手術（pulmonary thromboem—bolectomy）を行い救命し得た1例を経験したので報告する。

Life-saving emergency pulmonary thromboembo-lectomy in a case of acute massive pulmonary thro-mboembolism with syncope was reported. A 34 year-old man was admitted because of exertional dyspnea. His chest X-ray film, ECG, and arterial blood gas suggested the presence of pulmonary thromboem-bolism. Perfusion lung scan demonstrated multiple perfusion defects, and right-sided cardiac catheteriza-tion showed that the pulmonary arterial pressurewas elevated (mean ; 36 mmHg) and the cardiac in-dex was decreased (2. 4l/min/m²). Pulmonary arteri-ogram revealed multiple filling defects and cut-offs in both sides of the artery. Diagnosis of recurrent pulmonary thromboembolism was made. Sudden cardiovascular collapse occured with syncope and his clinical condition did not improve despite large doses of bolus infusion of urokinase. Emergency pulmonary thromboembolectomy was done one hour after the collapse, and the patient recovered well with some neurological deficit.