頸髓損傷患者併發急性肺與支氣管動脈栓塞

Acute Pulmonary and Bronchial Artery Embolism in a Patient with Cervical Spinal Cord Injury

脊髓損傷後有很高比例會併發靜脈血栓栓塞症（venous thromboembolism），如有發生此症則致死率 與致病率相當高。發生下肢靜脈血栓合併肺栓塞時會出現低血壓、低血氧等症狀，嚴重時可能需要進行 心肺復甦術。本案例為一位54 歲男性，因車禍意外導致頸椎C5-7 椎間盤突出合併頸髓壓迫造成四肢癱 瘓住院復健，進行復健運動時患者突感覺呼吸困難、臉色蒼白、冒冷汗、意識逐漸變模糊，血壓下降並呈現休克及血氧下降現象。醫療團隊緊急處置，並安排血液生化檢查、動脈血液氣體分析、D-dimer 檢測、 心電圖、心臟超音波與電腦斷層掃描，確認診斷患者為下肢靜脈血栓合併肺栓塞，施以抗凝血劑進行治 療，病況穩定後轉回病房。

A high proportion of patients with spinal cord injury would develop the complication of pulmonary embolism. The mortality rate of pulmonary embolism is very high during rehabilitation. When pulmonary embolism occurred, hypotension, desaturation and etc…, were also found. Emergent cardiopulmonary resuscitation was needed if the situation was quite severe. We reported a 54-year-old man who had cervical C5- C7 disc herniation and spinal cord compression with lower limbs paralysis underwent rehabilitation regularly. On the same day when the rehabilitation was taken, he suffered from dyspnea, pale-looking, cold sweating, consciousness disturbance, hypotension and hypoxia. After the evaluation and treatment, including blood examination, arterial blood gas analysis, D-dimer testing, electrocardiogram, cardiac ultrasound, computed tomography, oxygen therapy and vasopressor, pulmonary embolism was impressed and he was transferred to the intensive care unit immediately. At ICU, he took thrombolytic agent and was transferred to general ward for the stable condition.