経皮的心肺補助下に行われた気管気管支狭窄にたいする金属ステント治療

DOI PubMed 被引用文献5件 参考文献13件

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  • Treatment of Tuberculous Tracheobronchial Stenoses with Expandable Metallic Stent(EMS)s Placed during Percutaneous Cardiopulmonary Support(PCPS).

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A 63-year-old woman was taken to a hospital by ambulance because of dyspnea. She was admitted in nearly complete cardiopulmonary arrest. CPR was started immediately, and the patient was mechanically ventilated via a tracheostomy tube. Abnormally high airway pressures 40-50cm H2O were required during positive pressure ventilation. Saber-sheath like stenoses of the lower trachea 3cm long and left main stem bronchus 2cm long were found by bronchoscopy. It was difficult to pass a 3-mm-diameter bronchoscope through these stenoses. The right main stem bronchus was completely obstructed. A chest radiograph showed a completely collapsed right lung and a scarred upper lobe of the left lung, probably caused by previous tuberculosis. Weaning from the ventilator was attempted over three months. However, the patient could not breathe by herself because of airway obstruction. She was referred to our hospital for the placement of stents into the stenotic parts of the airways. A longitudinally connected Gianturcotype EMS, 15mm in diameter and 50mm long was placed in each area of stenosis under general anesthesia. During the placement of EMSs, POPS was used for 113 minutes instead of mechanical ventilation of the lungs. Hemodynamics were stable during PCPS. A bypass flow of 2.0-2.8l/min/m2 was used. Oxygen saturation of arterial blood taken from an earlobe was maintained at 100%. Blood taken from the left radial artery had a PaO2 of 269.4mmHg and a PaCO2 of 40.2mmHg. There were no complications after the procedure. One month later, the stenoses had become slightly dilated. The patient was able to walk when oxygen 0.5L/min was given through the tracheostomy tube. At that time, arterial blood gas analysis showed a pH of 7.346, a PaO2 of 122.3mmHg and a PaCO2 of 48.8mmHg.

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