術中肺血栓塞栓症を来した大腿骨頚部骨折の1例

Pulmonary Thromboembolism During Surgery for a Femoral Neck Fracture. Case Report

　80歳の女性で，大腿骨頚部骨折術中に肺血栓塞栓症を来した1例を報告する．発症早期より本症を疑い，迅速な治療を施行したことで救命することができた．術中動脈圧モニターは急変の早期発見に有用であった．本症例における肺血栓塞栓症発症リスク因子として，服用していた抗血小板薬の術前休薬および手術までの待機期間が挙げられる．静脈血栓塞栓症の兆候がなくとも抗血小板薬・抗凝固薬内服症例，中でも下肢外傷により術前安静臥床を要する症例では術前から予防策を講じる必要があると考えた．

　We report the case of an 80-year-old woman in whom pulmonary thromboembolism (PTE) occurred during surgery for a femoral neck fracture. The first sign of trouble was a sudden drop in blood pressure and O₂ saturation, and we immediately interrupted surgery and instituted resuscitation. Since PTE was suspected in the early stage, we were able to begin treatment immediately, and her clinical manifestations were ultimately reversed. An intraoperative arterial pressure monitoring system was very useful in detecting the sudden changes in the patient's condition. Suspension of an anti-platelet drug in the preoperative period and the length of the preoperative period may have been risk factors for PTE in this case. We concluded that measures of prevent venous thromboembolism (VTE) in the preoperative period are necessary in lower extremity trauma patients especially patients who usually take an antiplatelet agent or an anticoagulant.