@article{oai:gunma-u.repo.nii.ac.jp:00008080,
 author = {Ishikawa, Ai and Tobe, Masaru and Kunimoto, Fumio and Saito, Shigeru and 石川, 愛 and 戸部, 賢 and 国元, 文生 and 齋藤, 繁},
 issue = {3},
 journal = {The Kitakanto medical journal = 北関東医学},
 month = {Aug},
 note = {Journal Article, 症例は39 歳女性. 突然の呼吸困難とめまいを主訴に発症し, 緊急搬送となった. 造影CT で, 肺血栓塞栓症(PTE : Pulmonary thromboembolism) および深部静脈血栓症(DVT : Deep vessel thrombosis) と診断した.血栓症の危険因子として肥満, 高血圧症, 経口避妊薬内服歴があげられた. 入院後循環動態が安定していたため, PTE に対しては抗凝固療法を開始し, DVT に対しては血栓の大きさを考慮し下大静脈フィルターの適応はないと判断された. しかし第3病日の造影CT での再評価では肺血栓は増大しており心臓超音波検査でも肺高血圧所見を認めたため, 外科的血栓除去術を緊急的に行った. 血栓除去後すぐに心機能は回復せず, 体外循環下にICU 帰室したが,その後経過は良好で術後22日に独歩退院した.呼吸・循環動態の安定している肺血栓塞栓症の基本的治療は抗凝固療法だが, 奏功しない症例においては外科的血栓除去術を考慮すべきである., The mainstay of pulmonary embolism(PE)treatment is anticoagulation. If a patient with acute PE fails to respond to initial anticoagulation, with worsening cardiovascular instability and respiratory failure, then, surgical embolectomy should be considered. We present the PE case of a 39-year-old woman who was overweight and had oral contraceptives for a few months. The patient was hospitalized for a diagnosis of PE and started to receive anticoagulant therapy with heparin. But two days after,the patient suffered from worsening of PE. Though the patient’s cardiovascular stability was maintained with percutaneous cardiopulmonary support (PCPS) and intra aortic balloon pumping (IABP), the pulmonary thrombus was enlarged under the CT image. Also,right ventricle dysfunction was detected by echocardiography. And then, the patient undertook emergency surgical embolectomy. After the surgery, the patient needed PCPS support for two days for the right ventricle dysfunction. The patient was discharged from the intensive care unit without PCPS and IABP, four days after the surgery. The patient left the hospital on foot, 22 days after the surgery. We experienced a case of sub-massive PE during the anticoagulant therapy. The patient was successfully saved by emergency surgical embolectomy.},
 pages = {243--248},
 title = {肺血栓塞栓症に対し,外科的血栓除去術を施行し軽快した一例},
 volume = {64},
 year = {2014}
}