1 - marianna uigakukai.marianna-u.ac.jp/idaishi/www/323/07-32-3miyadu osamu.pdf · j 2003; 67: 612...

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腋腐腎腆 臦腫腭腣腯腨腲腻臶膄膼臄 Vol. 32, pp. 181187, 2004 腏腋腆腑腓腅腍腊腃腇腐腕腉腒腌腒腎腄腀腂腁腈腖腁腔腂 1 腜腟 腅腋腝 1 腟腛 腄腐 腛腋 腘腤 1 腥腏 腔腚 腡腍 腠腇 1 腛腋 1 腎腇 腃腑腍 1 腋腆腇 腗腢 腛腋 腡腍 1 腛腑 腞腓 腔腅 2 腔腆 腌腥 腇腡腍 1 腟腉 腙腜 腘腊 1 腝腢 腆腜 腘腤腍 3 腛腈 腄腐 腖腣 3 : 16 6 22 62 臕臠 2003 12 9 腗膵膙臠膤膊臨臙腗至腌臟膪膊臨膆臒腢臀膯腌腏臒膥腘膚腼腙膩腓腁腐腏腇22 臫腘膕膢膒膴腆腞膔臠臓膇臬腔腖腐腏膔臠腜腍腷膜臩膶臩臙腘臞臻腓臜臭臥腢膯腃腛腸腌腖腂腏腚膚腤腇腜腱臔臮PCPS腏腗腌腏腜腍腷臱腷腓腵臉腜腍腷腔膵腜腍腷腘臚臁腗膜臩臠膶腢腜腍腷膜臩膒腳膇腳腢膯腂腜腍腷腘膜腙膂自腌腏24 臅膉膥腗腙臇膣臜腙膁PCPS 臺腍腠腊腔腇臑PCPS 臺膥腙膱臙腖腉膚腼腌腎腘膥膅臬臈 膎腌腏膔臠膬腢腜腍腷膜臩膶臩臙腎腡腗腃臓膇臬腘臵腗至腌腒 PCPS 腗腝腠 臓膇臔腙膧腖臊臼腔膮腄腞腡腏腇腀腏腅 臒膥膔臠膜臩膶臩臙腤腇腜腱膜臩臙 腖腵腗腅腂腒膔臠膜臩膶臩臙 Acute Pulmonary Thromboembolism; A-PTE腙臖腖腂 腔腋腡腒腈腏 1腓腙腤腦腪腬腀臙膦膘腔腌 腘腀腋腇膨臚腌腒腂腠 2臒膥腖腕腗腭腟腍腠腴 腔腟臊臒腜膰膏臒腘腟腈腂腴臙腘 A-PTE 腇臯腺腌 3膫腖膎腢臗腉腊腔 腛腁腟臷腔腖腐腒腂腠膳膁腽膤膊臨臒膥腗膬A-PTE 臙腌腜腆臂臛臵腔 腖腐腏臙腗至腌膚腤腇腜腱Percutaneous Cardiopulmonary Support; PCPS腗腝腠臓膇腢膯腂臈膀膎腌腏臙腢膚膟腌腏臎臒膌腘 A-PTE 腾腴A-PTE 腘膔臠膌臆PCPS 腽膀 臠腗腑腂腒膮膻腢腺腄腒膲腍腠: IY62 臕臠: 膢膒膴腂腁腑: 44 : 膰膜腰臙膿膓膖臋61 : 膙臠膤膊臨臙腃腍腑: 2003 12 1 腗膵膙臠膤膊臨臙腘臊 腸腇腴臢膙膃腻腗腴腔腖腐腏12 9 腗致膍腗膵臟膪膊臨膆臒腢臀膯腌腏臊臒臷腖腉臒膥腘膚腼腛膩腓腁腐腏12 22 10 30 腹臃膖腧腮腀腩腯腥膢膒膴腇臑膡腌A-PTE 腘膐腂腗腒臓膇 腻腗腱腔腖腐腏1 臦腫腭腣腯腨腲腻臶膄臓膇膋2 腼膄3 臜臰膜膈膃腻 181 49

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Page 1: 1 - Marianna Uigakukai.marianna-u.ac.jp/idaishi/www/323/07-32-3Miyadu Osamu.pdf · J 2003; 67: 612 616. 18 Kasper W, Konstantinides S, Geibel A, Olschewski M, Heinrich F, Grosser

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Page 2: 1 - Marianna Uigakukai.marianna-u.ac.jp/idaishi/www/323/07-32-3Miyadu Osamu.pdf · J 2003; 67: 612 616. 18 Kasper W, Konstantinides S, Geibel A, Olschewski M, Heinrich F, Grosser

�����: �� 154 cm� �� 64 kg �Body massindex; BMI 27�, ����� ��� 50 mmHg

� ��� �� 80 ���� 7 L�������������������� 80� ��� � !�"�#�$%&'()*� � +,���-./&'( �0��1)2� 3�4'()*� ����: �56�#78��� D-9��:�;<� =���>&'( �Table. 1��

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����: I�6 83 ����JK�� III� V1�2�L�MG TN&'( �Fig. 2��

�����: IOPQ�RSGT�8CO�U,&'( ������: VWXYZ[.\�� 0]^�A?:_@`&ab2 c\��de8� fg)=���=���>&'(� Ihi:�CIj�U,&'( e8kl A-PTE &m� � n��op�q4rs2� ��t uv�)w)� (xyz{y�ID|} �Cardiopulmonary Resuscitation; CPR�&ab2 � � 30 �~� CPR ����t)� (� 11� 20������ PCPS &ab2 � +,���kl 15�?@�����_�:?� C,�3�kl 21 �?@�����_�:?&{�2�PCPS �T�&ab2 � PCPS ����82�������������� EBS ����� ��4� EBS ID��A&��2 � 2*2��t����l� CPR &�a2� PCPS 4��t��)2800��� I�v�82� 1.5 L�min�ab2 �!� CT��CD������� �¡8+D���#�0�¢��£&'( �Fig. 3�� �� CT �PCPS ����_�:?t+¤3��{�¥¦�§l� ¤¨©��1&ª«2�� t� ¬­®��y¯�v4'()*� � °�\� E±0����_�:?&CI���{�2 � °�c\kl1100 ���I�v�82� 1.9 L�min ²�³de8tv� � A-PTE �´2µ+,�3�� 5�?@�� pig tail ��:��� 8�?@�� 90 cm �

Fig. 2. The electrocardiogram demonstrated sinus rhy-

thm with inderted T wave in leads III� V1�2.

Fig. 1. Chest radiography demonstrating a Cardio-thor-

acic ratio of 61.8� and hyperlucent area in rightlung field and PCPS[s cannula in right atrium�

Table. 1. Laboratory Data

¶· ¸ ¹zº» ¼182

50

Page 3: 1 - Marianna Uigakukai.marianna-u.ac.jp/idaishi/www/323/07-32-3Miyadu Osamu.pdf · J 2003; 67: 612 616. 18 Kasper W, Konstantinides S, Geibel A, Olschewski M, Heinrich F, Grosser

������������ ������� ����������� Pro-UK ��������4500 IU� � ����� !�����"#$���%� ������&���'(�Fig. 4�� ���� )*+�,����-.��/01����2��#����� ���16 �3�� 4.8 L���4(� � 23 ��5678 9:!�� PCPS � 24 ;<="#"#$�>-$(� #�� %)*+�,�&?5@A'��4(� PCPS B�(��C@�D)E5�'F04(� A-PTE �G*+,�('� �-�H�

Gunther H.-�IJ�K�����(� �� CT�����2�/L��'F04(('MNO��P012�QR�� S3TU;< �activated clot-ting time; ACT� 5 2004�56�(� 24��57VW�X019"#�� 25 �018>Y9FZ:�F4(('� MNO��P01201[�I\O��8]^��(�2004 ; 1 _ 7 ��`� CT =!���(H<a

��5b����(>� *E=��>c�?@F&���'(� Hd-�AeBfg=h.�-�����'(� �ij25kfgl� �m9no5�'F�('pqrs��(� 1_ 8�� C�OtuOv��w��D'��Ex@A�FA�F4(�

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Gy=� A-PTE �;<*HI5 50�60 J7�z{� ��|}� 10�5*E 1;<C�~K"#��{��#4� 5�� �(�L=�*HI5Gy�1�50���1{��#1�� ��5� �����E�������'��>�l���#2���9�� ��.�M�����*N�O��*E� A-PTE>/����#3�� �:� ��6P����Q3RS��T��#U�-��E �Deep VenousThrombus; DVT� �+,��4(�900�1��A-PTE �*E�(EV�p��(� LEV�� L���WX1�CH���� �s"#�� DVT ��������� ���� ���� PTE ���A-PTE 5YA��V� 0.03��0.09���'1{#6�7�� ZM'�5[ F�9��� *E�(¡D�5\]'�F%|#('� ^¢=£F�D)E=�#� A-PTE � 90�Cl5Hd� DVT >¤�¥���1{��%8�9�� DVT �_¦`a>.b=�#� §c'� DVT �`a5d¨EZ�2e� ©5�fª� �g�=«�{�� ¬h`a���*­z{#$�>[�� DVT �fg����5 � -�i® � AeBfg �� �Bfg �� 3D-CT � MRV >¯�1{#� AeBfg5i®°F±��T"#jk>F�('l²³'���#>� fg�5´m�k�nTª>o{��#µZ>�#10�� Cl��p"#� golden standard �z{#-�i®� �� Hd-� CT��#q¶>rT�·�{#� �EV����5� ¸¹��3-�º��'

Fig. 3. Chest computed tomography showing total oc-

clusion of right main pulmonary artery and

thrombus in superior lobe� inferior lobe of leftpulmonary artery�

Fig. 4. Pulmonary angiography demonstrated reperfu-

sion of right main pulmonary artery�

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51

Page 4: 1 - Marianna Uigakukai.marianna-u.ac.jp/idaishi/www/323/07-32-3Miyadu Osamu.pdf · J 2003; 67: 612 616. 18 Kasper W, Konstantinides S, Geibel A, Olschewski M, Heinrich F, Grosser

��DVT� ��������DVT������� DVT ������������� ��� ���� DVT ������� DVT ��A-PTE �������������� ��������� ��� ������ DVT �������������!������DVT ����"�� 2001 ��� 6 # ACCP

�American College of Chest Physicians ConsensusStatement� �$���11�� ����%�&'(�)�*�� ����+������ ���� ���,���� �-�� .!/"�#0�-����,��123425�6�77���.!��8� 9$���� 6���� :;�%<&=&��'()*<&��)*<&=&����123425�>+��12�� ��?�123425 ACCP�123425�,@���� 1� -.��%�&'(/)� 1�2/)0A1������� 2� 2<�B3��C4���#5����6DEFG�H&'(�G78������ 3� ,�����9:���0!;<�IJK&5 =L>M�������78������� �N�-��?O��� 8�123425�@FP� Q"A.R� &'(STU���H&'(��B��� VWXYZC� �intermittent pneumatic compression; IPC���� 0!;<�IJK&5�78���� ������� D�EF�.!����� [\� DVT ��� G/"��� D�EF�WH���� ]^I���ZCZ�_��8�� `Vab�� �ZCZ�0;��8���cG��� ���� 8����8��"J�/"�����D�EF DVT ������� G������dFG��KeG fg���� A-PTE ��fL���� A-PTE �:%Mh �Cardiopulmonary arrest;CPA� �ijk(������N��Ol����13�� ����PQ� PCPS ���RmST����� A-PTE �bn�Ol14�� � ��oN��p�UqrV������ ?s Wt� A-PTE �Xu�� DVT �u2Y 50����Ol����15�� 8�8� � '()*�v+��Z[<& � �'()*�G\]�� 6����wx�Rmy^�z{�8��dFG��� ��� �p�v+��/"����� _`� DVTa+�����{/"�����dFG��

� PTE ����������� ��� � ����A-PTE �bc � Z�<&v+�������JK&516��<&�d|�e�� urokinase�fg}4'~���5�(�T�� �tissue plas-minogen activator;t-PA� �N���<&d|c���h����17�� ���ijk(�i�����a���\ Gj��8����� �kp�tl�N� A-PTE � � ���mq�w�Rmy^�G]^�����n����18�� �p�2<�B3����<&d|c��.!�o���������� <&��c��p�c� �!���19�20��������� PCPS �^<����S���qrs��� a)*<&d|c� ^F��� ���� <&���� p������ �mq�%t*<u���v�wG�� mq�Rmtx��y��dFG�� 7� 2 z������IVC filter ���� � ��� A-PTE ��NA� 7���� qrs��8�� �p����c�9h d{��|�������}.��� ��� A-PTE ���� PCPS �������������A-PTE �tl� 10��G 33� � 1`V�L����������1�5�21�� Rm���^���G~����� bc�n����� ���� �p 1 `V� PCPS ���� STRm����8��p���A ��¡�¢�/"��� A-PTE �a�� PCPS �]^£���� �h� � ���� v�������¤�¥� ¦�RmG��G/§����� x������ ����/"����8��N��cG��22��27�� A-PTE���w�RmG� %t*��=���¨:�©� ª:«�y^���� PCPS �¨K�G^<��t*¬��< <^tx� �!���� ­��®��%�bc�/"�� bcp�RmG���y�¯G���GP� 6�V����Rm� PCPS�ST��8����°� /"����� PCPS � !"�#$%�PCPS ±²¡��?�5³�´� � PCPS ��

�B3� 2<� <&=&����28�� PCPS ���` µw-.���� t�)*�����S�����¶�·�(� p��¸¬�2<� <¹rs�3��8��N�� 7 PCPS º^9 ���

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Page 5: 1 - Marianna Uigakukai.marianna-u.ac.jp/idaishi/www/323/07-32-3Miyadu Osamu.pdf · J 2003; 67: 612 616. 18 Kasper W, Konstantinides S, Geibel A, Olschewski M, Heinrich F, Grosser

����������� ���� ��������������� �������������������� �������� PCPS����� �!"#�$%%&�'��������!"#�� �(� ��������� ����� ��������)���*���� ��������+,-���������.�/�����0���(�"��12����!"#��

� �

34567�899:���� A-PTE ���;� PCPS � �;<�;�� 1�=>;�� ����%� 1��?� PCPS �@A����BC� D�!E!"#���� FG"H�����I��J��!K� LM�NHOP#QR��#��S:� 9: PTE �$%�;T9U DVT �VW

X&Y�VWXZ[�$%��'\]�!"��12�^����!"#��

����

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1237�1238.21� West, JW. Pulmonary Embolism. Med Clin

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28� ���� Z����J PCPS %����� ¡¢£¤¥¦Mw�� §�¨©ª� *+,�!-.«� ¬ 1­� h®¯� °±� 1998: 19�24�

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Page 7: 1 - Marianna Uigakukai.marianna-u.ac.jp/idaishi/www/323/07-32-3Miyadu Osamu.pdf · J 2003; 67: 612 616. 18 Kasper W, Konstantinides S, Geibel A, Olschewski M, Heinrich F, Grosser

Abstract

Successfully Resuscitated Case of Acute Pulmonary Embolism after

Hip Replacement Arthroplasty Operation.

Osamu Miyazu1, Masahiro Yamauchi1, Yoshiyuki Watanabe1, Masato Uno1, Atsushi Seki1,

Masayoshi Sakakibara1, Naoki Matsumoto2, Kiyoshi Nakazawa1, Fumihiko Miyake1,

Hiroshi Murakami3 and Haruo Makuuchi3.

Total hip replacement operation had been performed for sixty-two year-old female on Dec. 9th, 2003.

Post operative status had been stable until she developed sudden circulatory collapse after chest pain and

dyspnea on 22nd. Suspecting acute pulmonary embolism, percutaneous cardiopulmonary support system

�PCPS� was introduced after unsuccessful resuscitaion. Thromboembolic occlusions in the right mainpulmonary artery and upper�lower branch of the left pulmonary artery were demonstrated by pulmonaryarteriography. Clot-busting and aspiration therapy were attempted resulting in recovery of pulmonary blood

flow. Spontaneous heart beats and circulation resumed in 24 hours, and PCPS was successfully removed. No

complications occurred and she has completely rehabilitated to ordinary social life activities. PCPS was

found to be a useful method to support circulatory distress in serious acute pulmonary embolism.

1 Division of Cardiology, Department of Internal Medicine

2 Department of Pharmacology

3 Division of Cardiovascular Surgery, Department of Surgery St. Marianna University School of Medicine.

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