於肺栓塞摘除術中使用經食道心臟超音波之病例報告

Intraoperative TEE Monitoring on Pulmonary Thromboembolectomy-- A Case Report

在脊椎手術後併發肺栓塞的病例是少見的。我們報告一位61歲女性於開完脊椎手術7天後，突發性呼吸急促至本院求診。經過檢查確定是大量肺栓塞，但是經過內科用肝素治療，卻發生血小板過低過低的副作用。在栓塞溶解術失敗後，決定開刀取出血栓。在術中，我們使用經食道心臟超音波隨時監看血栓和心臟功能。術後病人於隔天拔管。並於兩個禮拜後，在無症狀和後遺症的情況下出院。經食道心臟超音波是一個在術中隨時觀察栓塞去除及心臟功能變化的絕佳工具。

We present a successful thromboembolectomy under intraoperative transesophageal echocardiography (TEE) monitoring on a woman with massive pulmonary embolism (PE). Sudden onset of dyspnea happened 7 days after lumbar spine surgery and ventilation/perfusion scan and angiography performed right away were suggestive of PE. Operation was performed 17 days later after invalid anticoagulant treatments and unavailing catheter fragmentation. Intraoperative TEE showed massive emboli in the main and right pulmonary arteries (MPA and RPA) and dilated right atrium (RA) with deviated intraatrial septum. Removal of the emboli was performed smoothly under TEE monitoring. The dilation of RA, right ventricle (RV) and PA were resolved soon after thromboembolectomy. The patient was extubated the next day with obvious improvement of clinical symptoms and discharged two weeks later without neurological sequale. We conclude that TEE can be an excellent tool not only for early diagnosing PE in high risk patients but also for intraoperative monitoring on removing emboli and managing cardiac functions.