유경횡복직근피판을 이용한 유방복원술시 폐색전증의 발병률과 위험인자

이상혁,이택종,엄진섭,손병호,안세현,이상도 대한성형외과학회 2006 Archives of Plastic Surgery Vol.33 No.2

Pulmonary thromboembolism is often clinically silent and difficult to diagnose, and can be fatal to patients with belated treatment. This complication is seen in patients who underwent TRAM breast reconstruction. Multiple factors are involved in this disease such as the presence of malignancy itself, major surgery and therapy-related interventions. TRAM surgery is a lengthy procedure involving mastectomy, flap surgery and abdominoplasty. The purpose of this study is to evaluate the incidence and the correlation between presurgical risk factors(BMI and age) of symptomatic pulmonary thromboembolism after TRAM surgery and the incidence. From July 2001 to March 2005 a total of 384 pedicled TRAM reconstruction of breast was performed in 382 patients at Asan Medical Center. The average of Body mass index was 21.9kg/m2 and mean age of the patients was 37.9 years old. We diagnosed symptomatic pulmonary thromboembolism using ventilation/ perfusion lung scan and pulmonary embolism computed tomography. Incidence of in-hospital symptomatic pulmonary thromboembolism was 1.3%. BMI and age showed no significant statistical relationship to pulmonary thromboembolism. But the incidence of symptomatic pulmonary thromboembolism in obese patients (BMI>25) was 3.75%. According to the guideline of the 7th American College of Chest Physicians Consensus Conference on Antithrombotic and Thrombolytic Therapy, the incidence of 3.75% was classified as high risk group. The prevention of pulmonary thromboembolism should be considered in cases of obese patients with low molecular weight heparin(BMI>25).

급성 폐혈전색전증의 중증도 평가에 있어 이중 에너지 전산화단층촬영의 진단적 유용성에 관한 연구

문성민,선현주,백장미,이승진,윤연홍,김윤현 대한영상의학회 2015 대한영상의학회지 Vol.72 No.1

Purpose: To evaluate the usefulness of dual-energy computed tomography (DECT) in severity assessment of patients with acute pulmonary thromboembolism (APTE). Materials and Methods: We evaluated 61 patients diagnosed as APTE from 2011 to 2012 in a retrospective analysis of the severity assessment indices according to Criteria by European Society of Cardiology as well as pulmonary CT angiographic obstruction score (OS) and lung perfusion index (pulmonary perfusion defect score; DS) by DECT. The correlation between OS, DS and the severity of pulmonary thromboembolism was evaluated using logit analysis. Results: Patients with high OS also showed significantly higher DS values (p < 0.001). There was a significant correlation between both the OS and DS values and the severity of the pulmonary thromboembolism using simple sequence logit analysis (p < 0.001). However, only the DS value showed a very high correlation with the severity of pulmonary thromboembolism using multiple sequence logit analysis. Conclusion: DECT provides a more useful marker for the diagnosis and severity assessment of pulmonary thromboembolism by checking the degree of lung perfusion as well as determining the existence of APTE in patients with suspected pulmonary thromboembolism. 목적: 급성 폐혈전색전증 환자의 중증도 평가에 있어 이중 에너지 전산화단층촬영(dual-energy computed tomography; 이 하 DECT)의 유용성에 대해 알아보고자 했다. 대상과 방법: 2011년부터 2012년까지 급성 폐혈전색전증으로 진단된 61명의 환자를 대상으로 후향적 분석을 했다. 대상 환자의 중증도 평가와 함께 DECT를 이용해 폐동맥 혈전색전지수(pulmonary CT angiographic obstruction score; 이하 OS)와 폐 관류결손지수(pulmonary perfusion defect score; 이하 DS) 정도를 평가했고 서열 로짓 분석을 통해 OS, DS, 그리고 폐혈전색전증의 중증도 간의 상관 관계를 분석했다. 결과: 높은 OS를 가진 폐혈전색전증 환자는 DS도 높은 값을 보였다(p < 0.001). 단순 서열 로짓 분석 때는 OS와 DS 모두 폐혈전색전증의 중증도와 높은 상관 관계(p < 0.001)를 보였지만 다중 서열 로짓 분석 이후에는 DS만이 폐혈전색전증의 중증도와 매우 높은 상관 관계를 보였다. 결론: 폐혈전색전증이 의심되는 환자에서 DECT는 급성 폐혈전색전증 유무를 확인하는 동시에 폐 실질의 관류 정도를 확인하여 폐혈전색전증의 진단뿐 아니라 중증도 평가에 더 유용한 지표를 제공하는 것으로 사료된다.

Case series of survivors and non-survivors with high risk pulmonary thromboembolism receiving extracorporeal membrane oxygenation

( Gae-eil Jang ),( Won Ho Jang ),( Yang Ki Kim ),( Jung Hwa Hwang ),( Somy Koo ),( Soo Taek Uh ),( Ki Up Kim ),( Bo Young Lee ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Background: Pulmonary thromboembolism is the most preventable but fatal cause of death in hospitalized patients. The main cause of death in pulmonary thromboembolism is right-heart failure due to acute pressure overload. In this sense, extracorporeal membrane oxygenation (ECMO) might be useful in maintaining hemodynamic stability and improving organ perfusion. Some previous studies have reported ECMO as a bridge to definitive therapy of pulmonary thromboembolism. However, little is known about which patients will benefit from ECMO. Methods: Patients who underwent ECMO due to pulmonary thromboembolism at a single university-affiliated hospital between January 2010 and December 2018 were retrospectively reviewed. Results: During the study period, 9 patients were receiving ECMO in high-risk pulmonary thromboembolism. The median age of the patients was 54 years and 6 patients were male. All nine patients had cardiac arrests and ECMO was started as extracorporeal cardiopulmonary resuscitation (E-CPR). One patient received tPA and thrombectomy and one patient underwent thrombectomy as definitive therapy. The others received ECMO as a sole therapy. Two out of nine patients survived. Those survivors had in-hospital cardiac arrests and received ECMO only. Compared to non-survivors, survivors tended to have a short interval between CPR to ECMO initiation (30 minutes vs 60 minutes). Conclusions: Although cardiac arrest before ECMO is known to be a risk factor, early decision to start ECMO and its rapid initiation might help to save those with cardiac arrest in high-risk pulmonary thromboembolism.

폐동맥혈전색전증과 사망에 대한 고찰

김유희 內務部 國立科學搜査硏究所 2001 國立 科學 搜査 硏究所 年報 Vol.33 No.-

항결핵 치료 전 발견된 폐결핵과 동반된 폐동맥 혈전색전증 1예

윤창용 ( Chang Yong Yun ),유창민 ( Chang Min Yu ),오유미 ( Yu Mi Oh ),안수민 ( Soo Min Ahn ),심형훈 ( Hyoung Hun Sim ),김은실 ( Eun Sil Kim ),유지원 ( Ji Won Yu ) 전북대학교 의과학연구소 2013 全北醫大論文集 Vol.37 No.1

Venous thrombosis and pulmonary thromboembolism results from a distortion in Virchow`s triad by venostasis, hypercoagulability, or vessel wall inflammation. There have been reported very low prevalence of venous thrombosis combined with mycobacterium tuberculosis infection. The pathogenesis may be associated with rifampin and the hypercoagulable state induced by acute infection. We report a case of pulmonary thromboembolism associated with pulmonary tuberculosis before antituberculosis treatment. A 21-year old young man who presented with cough and dyspnea didn`t have any risk factors for venous thrombosis but contrast-enhanced chest computed tomography and perfusion scan showed pulmonary thromboembolism. Even before antituberculosis treatment, pulmonary thromboembolism can be combined with pulmonary tuberculosis.

폐동맥혈전색전증과 사망에 대한 고찰

김유희,강현욱 大韓法醫學會 2001 대한법의학회지 Vol.25 No.1

Despite advances in our understanding of venous thromboembolic disease, the prevention, diagnosis and treatment of pulmonary thromboembolism remain a clinical challenged. In western country, pulmonary thromboembolism is common : its antemortem diagnosis is not. Its frequency in routine hospital autopsies is 5% ∼ 10%. Especially, pregnancy and orthopedic surgery are widely recognized to be physiologic slates with markedly elevated risk for thromboembolic complication Deep venous thrombosis is very frequent after surgery, and its major complication, pulmonary thromboembolism, is the most frequent cause of postoperative death. The reduction of this cause of mortality is mainly based on its prevention rather than its therapy. All of these 40 cases were autopsied between 1997 ∼ 1999 in National Institute of Scientific Investigation(NISI) and the causes of death were verified pulmonary throaboembolism. The aims of study were to investigate post-mortem verified causes of death, pulmonary thromboembolism, to cirrelate these with clinical practice, to identify the potential for prevention according to the literature and to contribute to decrease the mortality rate due to pulmonary thromboembolism.

폐색전증을 동반한 원발성 항인지질증후군

이재범 ( Jae Beom Lee ),심윤수 ( Yun Su Sim ),노영욱 ( Young Wook Noh ),박혜성 ( Hye Sung Park ),태정현 ( Chung Hyun Tae ),임소연 ( So Yeon Lim ),전윤희 ( Yoon Hee Jun ),류연주 ( Yon Ju Ryu ),천은미 ( Eun Mi Chun ),이진화 ( Jin Hw 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.63 No.1

Antiphospholipid syndrome (APS) causes recurrent thromboses and morbidity during pregnancy, including fetal loss. This malady is associated with the persistent presence of anticardiolipin antibody or lupus anticoagulant. The pulmonary manifestations of antiphospholipid syndrome include pulmonary thromboembolism, pulmonary hypertension, acute respiratory distress syndrome, etc. Pulmonary thromboembolism is often the initial manifestation of antiphospholipid syndrome and a timely diagnosis is critical due to the high mortality rate. We herein report on a 19-year-old man with pulmonary thromboembolism that was caused by primary antiphospholipid syndrome. He presented with blood-tinged sputum, fever and epigastric pain, and his chest computerized tomography showed pulmonary thromboembolism. The other possible causes of pulmonary thromboembolism were excluded and the diagnosis of primary antiphospholipid syndrome was confirmed by the lupus anticoagulant that was present on two occasions six weeks apart. We also discuss the nature and management of antiphospholipid syndrome, along with a brief review of the relevant literatures. (Tuberc Respir Dis 2007; 63: 72-77)

급성 폐혈전색전증 환자에서 예후 인자로서 혈중 BNP의 의의

이수진 ( Su Jin Lee ),이재형 ( Jae Hyung Lee ),박지영 ( Ji Young Park ),조우성 ( Woo Sung Jo ),김지은 ( Ji Eun Kim ),김기욱 ( Ki Uk Kim ),박혜경 ( Hye Kyung Park ),김윤성 ( Yun Seong Kim ),이민기 ( Min Ki Lee ),박순규 ( Soon Kew P 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.60 No.5

연구배경 : 폐혈전색전증은 혈역학적 안정성과 우심부전의 정도가 중요한 예후인자이다. 우심부전을 조기에 파악하는 것이 중요하지만 실제 임상에서는 판단이 쉽지 않은 경우가 많으므로 심초음파를 포함한 다양한 진단 방법이 연구되고 있다. 저자들은 급성폐혈전색전증의 예후 인자로서의 혈중 BNP를 평가 하고자 하였다. 방법 : 2002년 1월부터 2005년 5월까지 부산대학교병원 응급실을 내원하여 급성 폐혈전색전증으로 진단된 환자중 BNP 검사와 심초음파 검사를 시행하였던 34명의 환자를 대상으로 의무기록을 검토하였다. 예후 예측인자로 중환자실 입실여부, 인공 환기 치료 유무, 활력징후의 안정성여부, 합병증의 동반, 사망여부, 심초음파의 폐동맥압력 값과 삼첨판막의 역류정도를 설정하여 혈중 BNP 농도와의 연관성을 평가하였고 혈역학적 안정성을 기준으로 두 군으로 나누어 두 군을 구분하는 BNP의 cutoff 값을 구하였다. 결과 : 활력징후의 안정성 여부, 우심실 수축기압과 삼첨판막의 역류 정도, 기계환기 시행여부, 사망여부가 혈중 BNP 농도와 통계적으로 유의한 상관관계를 보였으며 활력징후 안정성에 대한 다중회귀분석을 시행한 결과 사망, BNP 농도, 기계 환기 여부가 통계적 의의를 보였다. 활력징후 안정성을 기준으로 안정군과 불안정군으로 나눌 때 양군의 분류를 위한 BNP 농도의 cut-off level은 377.5 pg/dl에서 가장 민감도와 특이도가 높았다. 결론 : 혈중 BNP는 여러 예후 예측인자들과 통계적으로 유의한 상관 관계를 보였고 측정이 쉽고 빠른 시간 내 결과를 확인할 수 있으므로 폐혈전색전증 환자의 우심부전 정도를 평가하기 위한 심초음파나 폐혈관 조영술등의 검사가 어려운 경우나 이 값들을 보정하는 경우에 있어서 유용한 예후 인자로 고려 할 수 있을 것으로 생각된다. Background : Vital stability and right side heart failure are major prognostic factors of acute pulmonary thromboembolism. While it is important to recognize right side heart failure, it is often difficult in real practice. Recently, several studies have described early diagnostic tools for detecting right side heart failure including echocardiography and biochemical markers. This study, we evaluated the prognostic role of the B-type natriuretic peptide (BNP) in an acute pulmonary thromboembolism. Methods : Thirty-four patients with a diagnosis of acute pulmonary thromboembolism were enrolled in the study. The BNP levels were measured and echocardiography was performed at the Emergency Department. Data on the prognostic factors including ventilatory support, vital stability, pulmonary artery pressure, degree of tricuspid valve regurgitation, complications and death was collected from the patients` medical records. The patients with an acute pulmonary thromboembolism were divided into two groups based on the vital stability and the BNP level and the cutoff values and prognostic factors of the two groups were compared. Results : The predictors of the vital stability that influence the prognosis of patients with acute pulmonary thromboembolism were the BNP level, ventilatory support and death. The plasma BNP levels showed a strong correlation with the vital stability, ventilatory support, thrombolytic therapy and death. When the BNP cutoff level was set to 377.5 pg/dl in a ROC curve, the sensitivity and the specificity for differentiating between the groups with stable or unstable vital signs was 100% and 90%, respectively. Conclusion : This study indicates that a measurement of the plasma BNP levels may be a useful prognostic marker in patients with an acute pulmonary thrombo-embolism. (Tuberc Respir Dis 2006; 60: 540-547)

대퇴골 골절 환자에서 척추경막외병용 마취 후 발생한 폐색전증

유동근 ( Dong Geun You ),이정현 ( Jeong Hyun Lee ),이미현 ( Mi Hyun Lee ),최은미 ( Eun Mi Choi ),최영룡 ( Young Ryong Choi ),정미화 ( Mi Hwa Chung ),강화자 ( Wha Ja Kang ) 경희대학교 경희의료원 2014 慶熙醫學 Vol.29 No.2

Pulmonary thromboembolism in patient receiving hip and lower extremity orthopedic surgery is not uncommon and can cause life-threatening event. Because of its non-specific symptom, it is not easy to make diagnosis and treat promptly in operating room. Rapid and accurate access of pulmonary thromboembolism is very important in good prognosis of high risk patients. It can develop any time in perioperative time, so that careful monitoring to patient is necessary to early diagnosis. We report a case in which develop pulmonary thromboembolism just after providing combined spinal-epidural anesthesia for femur neck fracture surgery. Because we do nothing but only changing position lateral to supine, change of position must be a factor of developing pulmonary thromboembolism.

Open Pulmonary Thromboembolectomy in Patients with Major Pulmonary Thromboembolism

이삭,송석원,이기종,윤영남,유경종,장병철 연세대학교의과대학 2008 Yonsei medical journal Vol.49 No.6

Purpose: We retrospectively analyzed open pulmonary thromboembolectomy in patients with acute and chronic pulmonary thromboembolism. Materials and Methods: Between August 1990 and May 2005, 12 consecutive patients with acute and chronic pulmonary thromboembolism underwent open pulmonary thromboembolectomy at Yonsei Cardiovascular Center. Their mean age was 47.5 years, and 7 of the patients were female. Among 12 patients, 5 had acute onset, and 7 had chronic disease, and 9 patients were associated with deep venous thrombosis. Extent of pulmonary embolism was massive in 3 patients with hemodynamic instability, and submassive in 8 patients. Preoperative echocardiogram revealed elevated right ventricular pressure in all patients, and 7 patients were in NYHA functional class III or IV. Pulmonary thromboembolectomy was performed in all patients under total circulatory arrest. Results: There were 2 hospital deaths (16.7%). Among the patients who survived, mean right ventricular pressure was decreased significantly from 64.3mmHg to 34.0mmHg with improvement of NYHA functional class. Conclusion: Open pulmonary thromboembolectomy is thought to be an immediate and definitive treatment for massive pulmonary embolism with optimal results. Even though operative mortality is still high, early diagnosis and immediate surgical intervention in highly selective patients may improve the clinical outcome.