急性肺血栓塞栓症の重症度別背景と治療成績

肺血栓塞栓症179 例を重症度別に広範型，亜広範型，非広範型に分類し，治療成績を検討した．抗凝固療法を標準治療とし，重症例では出血リスクに応じて血栓溶解療法，肺塞栓除去術を使い分けた．循環維持困難症例には経皮的体外循環補助装置を導入し，中枢性DVT 合併例に下大静脈フィルターを留置した．非広範型肺血栓塞栓症115 例中95.7％に抗凝固療法を行い，47.0％に下大静脈フィルターを留置した．亜広範型肺塞栓29 例中48.3％に血栓溶解療法を，93.1％に下大静脈フィルターを留置した．血栓溶解療法ハイリスク例3 例に，肺塞栓除去術を行った．両群とも肺塞栓による死亡はなかった．広範型35 例中，心停...

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Published in静脈学 Vol. 27; no. 2; pp. 53 - 59
Main Authors 青木, 哉志, 大徳, 和之, 谷口, 哲, 服部, 薫, 小渡, 亮介, 鈴木, 保之, 千代谷, 真理, 福田, 和歌子, 福田, 幾夫, 近藤, 慎浩, 皆川, 正仁
Format Journal Article
LanguageJapanese
Published 日本静脈学会 2016
Subjects
急性肺血栓塞栓症
経皮的心肺補助装置
肺塞栓除去術
静脈血栓塞栓症
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ISSN0915-7395
2186-5523
DOI10.7134/phlebol.16-08

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Abstract 肺血栓塞栓症179 例を重症度別に広範型，亜広範型，非広範型に分類し，治療成績を検討した．抗凝固療法を標準治療とし，重症例では出血リスクに応じて血栓溶解療法，肺塞栓除去術を使い分けた．循環維持困難症例には経皮的体外循環補助装置を導入し，中枢性DVT 合併例に下大静脈フィルターを留置した．非広範型肺血栓塞栓症115 例中95.7％に抗凝固療法を行い，47.0％に下大静脈フィルターを留置した．亜広範型肺塞栓29 例中48.3％に血栓溶解療法を，93.1％に下大静脈フィルターを留置した．血栓溶解療法ハイリスク例3 例に，肺塞栓除去術を行った．両群とも肺塞栓による死亡はなかった．広範型35 例中，心停止での発症4 例は急性期に死亡，他の31 例中3 例に経皮的体外循環補助装置（PCPS）導入，13 例に肺塞栓除去術，4 例に血栓溶解療法，13 例に単独抗凝固療法を行い，3 例（9.7％）を失った．亜広範型肺血栓塞栓症では出血リスクに応じた治療法選択，広範型肺血栓塞栓症では外科手術が有効であった．
AbstractList 「要約」: 肺血栓塞栓症179例を重症度別に広範型, 亜広範型, 非広範型に分類し, 治療成績を検討した. 抗凝固療法を標準治療とし, 重症例では出血リスクに応じて血栓溶解療法, 肺塞栓除去術を使い分けた. 循環維持困難症例には経皮的体外循環補助装置を導入し, 中枢性DVT合併例に下大静脈フィルターを留置した. 非広範型肺血栓塞栓症115例中95.7%に抗凝固療法を行い, 47.0%に下大静脈フィルターを留置した. 亜広範型肺塞栓29例中48.3%に血栓溶解療法を, 93.1%に下大静脈フィルターを留置した. 血栓溶解療法ハイリスク例3例に, 肺塞栓除去術を行った. 両群とも肺塞栓による死亡はなかった. 広範型35例中, 心停止での発症4例は急性期に死亡, 他の31例中3例に経皮的体外循環補助装置(PCPS)導入, 13例に肺塞栓除去術, 4例に血栓溶解療法, 13例に単独抗凝固療法を行い, 3例(9.7%)を失った. 亜広範型肺血栓塞栓症では出血リスクに応じた治療法選択, 広範型肺血栓塞栓症では外科手術が有効であった.
肺血栓塞栓症179 例を重症度別に広範型，亜広範型，非広範型に分類し，治療成績を検討した．抗凝固療法を標準治療とし，重症例では出血リスクに応じて血栓溶解療法，肺塞栓除去術を使い分けた．循環維持困難症例には経皮的体外循環補助装置を導入し，中枢性DVT 合併例に下大静脈フィルターを留置した．非広範型肺血栓塞栓症115 例中95.7％に抗凝固療法を行い，47.0％に下大静脈フィルターを留置した．亜広範型肺塞栓29 例中48.3％に血栓溶解療法を，93.1％に下大静脈フィルターを留置した．血栓溶解療法ハイリスク例3 例に，肺塞栓除去術を行った．両群とも肺塞栓による死亡はなかった．広範型35 例中，心停止での発症4 例は急性期に死亡，他の31 例中3 例に経皮的体外循環補助装置（PCPS）導入，13 例に肺塞栓除去術，4 例に血栓溶解療法，13 例に単独抗凝固療法を行い，3 例（9.7％）を失った．亜広範型肺血栓塞栓症では出血リスクに応じた治療法選択，広範型肺血栓塞栓症では外科手術が有効であった．
Author 福田, 和歌子
服部, 薫
大徳, 和之
皆川, 正仁
青木, 哉志
谷口, 哲
福田, 幾夫
小渡, 亮介
千代谷, 真理
近藤, 慎浩
鈴木, 保之
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17) Takahashi H, Okada K, Matsumori M, et al: Aggressive surgical treatment of acute pulmonary embolism with circulatory collapse. Ann Thorac Surg 2012; 94: 785–791
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3) JCS Joint Working Group: Guidelines for the diagnosis, treatment and prevention of pulmonary thromboembolism and deep vein thrombosis (JCS 2009). Circ J 2011; 75: 1258–1281
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13) Gray HH, Morgan JM, Paneth M, et al: Pulmonary embolectomy for acute massive pulmonary embolism: an analysis of 71 cases. Br Heart J 1988; 60: 196–200
20) Stein PD, Alnas M, Beemath A, et al: Outcome of pulmonary embolectomy. Am J Cardiol 2007; 99: 421–423
9) Kanter DS, Mikkola KM, Patel SR, et al: Thrombolytic therapy for pulmonary embolism. Frequency of intracranial hemorrhage and associated risk factors. Chest 1997; 111: 1241–1245
References_xml – reference: 4) Prandoni P, Lensing AW, Piccioli A, et al: Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 2002; 100: 3484–3488
– reference: 7) Sadeghi A, Brevetti GR, Kim S, et al: Acute massive pulmonary embolism: role of the cardiac surgeon. Tex Heart Inst J 2005; 32: 430–433
– reference: 15) Meneveau N, Séronde MF, Blonde MC, et al: Management of unsuccessful thrombolysis in acute massive pulmonary embolism. Chest 2006; 129: 1043–1050
– reference: 1) Kitamukai O, Sakuma M, Takahashi T, et al: Incidence and characteristics of pulmonary thromboembolism in Japan 2000. Intern Med 2003; 42: 1090–1094
– reference: 19) Neely RC, Byrne JG, Gosev I, et al: Surgical Embolectomy for Acute Massive and Submassive Pulmonary Embolism in a Series of 115 Patients. Ann Thorac Surg 2015; 100: 1245–1251; discussion 1251–1252
– reference: 10) Sanchez O, Planquette B, Meyer G: Management of massive and submassive pulmonary embolism: focus on recent randomized trials. Curr Opin Pulm Med 2014; 20: 393–399
– reference: 13) Gray HH, Morgan JM, Paneth M, et al: Pulmonary embolectomy for acute massive pulmonary embolism: an analysis of 71 cases. Br Heart J 1988; 60: 196–200
– reference: 18) Kadner A, Schmidli J, Schenhoff F, et al: Excellent outcome after surgical treatment of massive pulmonary embolism in critically ill patients. J Thorac Cardiovasc Surg 2008; 136: 448–451
– reference: 8) Kasper W, Konstantinides S, Geibel A, et al: Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. J Am Coll Cardiol 1997; 30: 1165–1171
– reference: 11) Konstantinides SV, Torbicki A, Agnelli G, et ai: Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014; 35: 3033–3069
– reference: 2) Dauphine C, Omari B: Pulmonary embolectomy for acute massive pulmonary embolism. Ann Thorac Surg 2005; 79: 1240–1244
– reference: 16) Sharma GV, McIntyre KM, Sharma S, et al: Clinical and hemodynamic correlates in pulmonary embolism. Clin Chest Med 1984; 5: 421–437
– reference: 20) Stein PD, Alnas M, Beemath A, et al: Outcome of pulmonary embolectomy. Am J Cardiol 2007; 99: 421–423
– reference: 3) JCS Joint Working Group: Guidelines for the diagnosis, treatment and prevention of pulmonary thromboembolism and deep vein thrombosis (JCS 2009). Circ J 2011; 75: 1258–1281
– reference: 5) van Es N, Di Nisio M, Bleker SM, et al: Edoxaban for treatment of venous thromboembolism in patients with cancer. Rationale and design of the Hokusai VTE-cancer study. Thromb Haemost 2015; 114: 1268–1276
– reference: 6) Kearon C, Akl EA, Ornelas J, et al: Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest 2016; 149: 315–352
– reference: 17) Takahashi H, Okada K, Matsumori M, et al: Aggressive surgical treatment of acute pulmonary embolism with circulatory collapse. Ann Thorac Surg 2012; 94: 785–791
– reference: 21) Goldhaber SZ: Surgical pulmonary embolectomy: the resurrection of an almost discarded operation. Tex Heart Inst J 2013; 40: 5–8
– reference: 9) Kanter DS, Mikkola KM, Patel SR, et al: Thrombolytic therapy for pulmonary embolism. Frequency of intracranial hemorrhage and associated risk factors. Chest 1997; 111: 1241–1245
– reference: 14) Meyer G, Tamisier D, Sors H, et al: Pulmonary embolectomy: a 20-year experience at one center. Ann Thorac Surg 1991; 51: 232–236
– reference: 12) Fukuda I, Taniguchi S, Fukui K, et al: Improved outcome of surgical pulmonary embolectomy by aggressive intervention for critically ill patients. Ann Thorac Surg 2011; 91: 728–732
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Snippet 肺血栓塞栓症179 例を重症度別に広範型，亜広範型，非広範型に分類し，治療成績を検討した．抗凝固療法を標準治療とし，重症例では出血リスクに応じて血栓溶解療法，肺塞...
「要約」: 肺血栓塞栓症179例を重症度別に広範型, 亜広範型, 非広範型に分類し, 治療成績を検討した. 抗凝固療法を標準治療とし, 重症例では出血リスクに応じて血栓溶解療...
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SubjectTerms 急性肺血栓塞栓症
経皮的心肺補助装置
肺塞栓除去術
静脈血栓塞栓症
Title 急性肺血栓塞栓症の重症度別背景と治療成績
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