脳血管障害患者に発生した肺塞栓症—自験5症例の検討

Pulmonary Embolism Complicated with Stroke:Analysis of 5 cases

I．はじめに

　肺塞栓症（pulmonary embolism，以下PEと略す）は欧米ではよく知られているが本邦では少ないとされている．しかしながら脳血管障害患者では下肢の深部静脈血栓症（deep venous thrombosis，件下DVTと略す）の危険性が高く，その結果，続発するPEも少なからず存在するものと考えられる．特に意識障害がある場合，症状を訴えることが少ないため本症は見逃されやすく，時に重篤な経過をたどることがある．今回我々は本症の5例を経験したので，本症発生の危険因子，診断，治療などについて検討を加え報告する．

Abstract

Though pulmonary embolism (PE) has been thought to be rare, the incidence seems to be increasing recent-ly. During the past 10 years, the authors have encoun-tered 5 cases of PE among stroke patients. There were 2 males and 3 females, aged 51 to 71 years (mean age ; 63 years). The mean time between admission and onset of PE was 23 clays. As to the primary disease to be treated, 5 patients had subarachnoid hemorrhage and one had intracerebral hemorrhage. Generally, PE tends to be overlooked or misdiagnosed because of the fact that stroke patients are often in a state of unconscious-ness. In our series, only one patient complained of dyspnea and the other 4 patients clue to unexplained sudden tachycardia, tachypnea and hypoxemia were suspected to have PE. Deep venous thrombosis known as the risk factor leading to PE was presented in 3 pa-tients. Especially in one patient, femoral venous cathe-terization was considered as a risk factor possibly lead-ing to deep venous thrombosis. Regarding the diagnosis of PE, the roles of electrocardiogram and of chest x-ray film were small. In 3 patients, the elevation of the dia-phragm was the only abnormal finding on chest X-ray. On the other hand, the Icing scintigram with "mTc-MAA was a useful method for definitive diagnosis of PE. In 3 patients, filling defects were demonstrated on the lung perfusion scintingrams. Consequently, we emphasize that PE must be kept in mind when tachy-cardia, tachypnea and hypoxemia appear suddenly. Prompt diagnosis and treatment are required. Also, of importance is the prophylactic management of deep venous thrombosis which is considered as a high risk factor leading to PE.