《11》多彩な経時的心電図変化を示しPCPSにても救命し得なかった劇症型心筋炎の症例
A case of fulminant myocarditis with varied sequentilal changes of ECGs, whose life has not been saved despite of intensive therapies such as PCPS
心臓VoL.41 suppl.3 (2009)
https://www.jstage.jst.go.jp/article/shinzo/41/SUPPL.3/41_S3_69/_pdf
･･･････････
急性心筋梗塞のPCI施行後96時間以内にスタチン剤投与すると重篤な心血管大イベントが67％減少した、特に不安定狭心症を減らした。との報告あり
↓スタチン剤の横紋筋融解症には心筋の壊死の場合もあるので一応
平成21年度 薬剤疫学的手法を利用した医薬品適正使用 p2より～スタチン剤
http://www.jshp.or.jp/gakujyutu/houkoku/h21gaku2.pdf
p11より～
http://www.mhlw.go.jp/shingi/2006/10/dl/s1019-4d8.pdf
以前、リピトール（上記《11》のアトルバスタチン）を数日服用し右下腿の激痛→横紋筋融解症→内反尖足の変形拘縮→杖歩行、の30歳台前半の人がいました。リピトールが原因と書いたのは本人が右足激痛で病院に電話したところリピトールの中止を言われたとのこと。
30歳前半なのですがⅡ型で、インスリン60単位以上（Ⅰ型ではなく）の人でした（治療は全額公費のかた）血糖コントロールが大変だった人でしょうか。その60単位以上の人は○正施設入所後、半年でインスリン8単位になりました（8単位は実質、経口薬オンリーになる時期。8単位でも低血糖（インスリン治療してる人は歩行しただけで低血糖になることがあり歩行するとインスリン必要量が減る（←歩行は大きな筋、大腿四頭筋と大殿筋が収縮するから））
半年で8単位に減るのは嘘だと思いますか？居室から工場へ移動時にフラフラして時間がかかる、転倒した、と診察室に連れてこられる→低血糖、インスリン単位減量→毎日診察室で測ってもらい毎日単位減量→8単位になり非常勤Drの診察順番へ（経口薬オンリーにならないで8単位が続いてました）
･･････････････････
wikiより引用開始
急性心筋炎は、無症状の場合もあるが、多くは感冒様症状 (かぜ症候群) や消化器症状などの前駆症状を伴う。前駆症状の1～2週間後に、胸痛、心不全症状、ショック、不整脈などの症状を呈する。
上述のとおり、心筋炎は特徴的な所見に乏しい疾患であるが、かろうじて特徴を見いだせるのが心電図である。心筋炎の急性期には、ほとんどの症例で完全房室ブロック（Ⅱ, Ⅲ度）、陰性T波、ST変化、心室性期外収縮（PVC）などの異常が見られる。また、これらに比べると稀ではあるが、心室頻拍（VT）、異常Q波、心房細動（AF）などが見られることもある。
非特異的ST変化はほぼ全例に認められる。R波減衰、異常Q波は、ほぼ半数に認められる。
また、心筋細胞の障害をきたすことから、一般生化学検査においては心筋逸脱酵素（CPK, AST, LDH）が上昇する。トロポニンTは迅速診断キットがあり、早期から異常を呈し、心筋特異的物質であることから、診断に特に有用である。BNP,NT-proBNPは心機能の把握に有用である。
心エコーでは、軽度の内腔拡大と心膜液貯留のほか、左室の壁運動低下と駆出率の著明な低下、壁肥厚などが認められる。
治療 現在はそれぞれのウイルスに対しては抗ウイルス薬を投与する他には、対症療法(PCPSや利尿剤など)とステロイド・γグロブリン投与しか選択肢がない状況である。
引用終わり
･･････････････････
《12》インフルエンザA型ウイルスによる劇症型心筋炎の1剖検例
A case of fluminant myocarditis caused by influenza A virus
心臓Vol,32(2000)No.2p.102-106
https://www.jstage.jst.go.jp/article/shinzo1969/32/2/32_102/_pdf
《13》新型インフルエンザA/H1N1に合併した劇症型心筋炎に経皮的心肺補助PCPSを導入し救命した一例
A patient who survived 2009 influenza A/H1N1-associated fulminant myocarditis with percutaneous cardiopulmonary support（PCPS）
日救急医会誌.2010;21:804-810
https://www.jstage.jst.go.jp/article/jjaam/21/9/21_9_804/_pdf
We describe a patient who survived 2009 influenza A/H1N1-associated fulminant myocarditis with critical care including percutaneous cardiopulmonary support (PCPS).
A 24-year-old female was diagnosed in November 2009 with influenza A and received oseltamivir.
Although her fever decreased, she experienced frequent vomiting and diarrhea 5 days after disease onset and was transfered to our hospital the following day.
Electrocardiograms showed ST-segment elevation in leads Ⅱ, Ⅲ, aVf, and V3-6, with increase in creatine kinase and troponin T levels.
Cardiac ultrasonography revealed marked overall reduction of wall motion, establishing a diagnosis of myocarditis.
Following ICU admission, general management was provided by intraaortic balloon pumping (IABP) with catecholamines, with continuous homodiafiltration (CHDF) to address acute renal failure.
Next morning, cardiopulmonary arrest was happened and PCPS was initiated.
Following PCPS circuit replacement on day 4, cardiac function gradually improved till weaning from both PCPS and IABP on day 7 and CHDF on day 8.
Prolonged mechanical ventilation due to airway hemorrhage and left pulmonary atelectasis ended with tracheal tube removal on day 15.
She was discharged without neurological sequelae on day 33.
PCPS, initiated without delay upon in-hospital cardiopulmonary arrest, enabled her survival with standard supportive care alone.
《14》健康診断の心電図にて変動が認められた突然死の症例
A case of sudden cardiac death with rapid progression of deterioration of heart function, unknown etiology and ventricular fibrilation
心臓Vol.40(2008)No.Supple3 p.21-28
https://www.jstage.jst.go.jp/article/shinzo1969/40/Supplement3/40_17/_pdf
《15》健診心電図異常でみつかった両心房内巨大粘液腫の1例
A case of biatrial giant myxoma revealed by EKG abnormality on annual medical examination
心臓Vol.38(2006)No.9 p.935-941
https://www.jstage.jst.go.jp/article/shinzo1969/38/9/38_935/_pdf
《16》循環不全を呈した診断のついていない白血病患者に経皮的心肺補助装置を導入した症例
A case of irreverently applied PCPS in an undiagnosed leukemia patient who developed cardiopulmonary collapse
日本集中治療医学会誌Vol.10 (2003) No.4 p347-351
https://www.jstage.jst.go.jp/article/jsicm1994/10/4/10_4_347/_pdf
A 44 year-old man was refered to the ICU for his sudden and severe dyspnea.
His physical findings, chest radiograph, and ECG suggested acute pulmonary thromboembolism.
Although his trachea was intubated due to severe hypoxemia and rapidly progressing conscious disturbance, it did not improved hypoxemia and, worse than that, induced sudden hypotention and pulmonary arterial congestion.
None of medical treatments like inotropes including epinephrine, fluid administration, and mechanical ventilation did not improve his condition and we started emergent percutaneous cardiopulmonary support system (PCPS) to prevent circulatory collapse and probable death.
PCPS raised his systolic blood pressure from 70mmHg to 100mmHg.
We found hepatosplenomegaly after the beginning of PCPS by palpating his distended abdomen.
Emergent pulmonary angiography showed multiple filling defects in the distal pulmonary arteries.
Continuous hemodiafiltration (CHDF) was carried out for acute renal failure presenting anuria, hyperkalemia, and metabolic acidosis.
Subsequent laboratory findings suggested acute crisis of chronic myelogenic leukemia as his background and we considered that pulmonary thromboembolism had resulted from hyperleukocytosis and hyperthrombocytosis.
PCPS was discontinued six hours after the initiation because of gradual occlusion of artificial lung membrane and finally the patient lost his life.
Autopsy revealed extensive infiltration of chronic myelocytic leukemic cells in major organs including both lungs.
The final diagnosis is pulmonary thromboembolism by blastic crisis of chronic myelocytic leukemia and it is retrospectively non-indicative for PCPS.
This case highlights the clinical, radiographic and histolic features of pulmonary leukostasis and reminds us that it is difficult to exclude fatal malignant diseases during resuscitation.
《17》壊死性好酸球性心筋炎の1剖検例
An autopy case of necrotizing eosinophilic myocarditis
心臓Vol.35 No.8(2003)
https://www.jstage.jst.go.jp/article/shinzo1969/35/8/35_581/_pdf
《18》術後心室頻拍に対し長期補助循環が有用であった心筋梗塞後乳頭筋断裂の1例
Surgical treatment for papillary muscle rupture after myocardial infarction with sustained ventricular tachycardia
日本心臓血管外科会誌Vol.37(2008)No.2p.140-143
https://www.jstage.jst.go.jp/article/jjcvs/37/2/37_2_140/_pdf
We report an operative case of papillary muscle rupture after myocardial infarction with sustained ventricular tachycardia.
A 56-year-old man referred to our emergency room in shock.
Emergency CAG showed total occlusion of the left circumflex artery, in which we placed a metallic stent.
Even after re-canalization of the coronary artery was achieved, circulation was unstable.
IABP and PCPS were used to maintain the systemic circulation.
Trans-esophageal echocardiography showed papillary muscle rupture and massive mitral regurgitation.
Under total cardiopulmonary bypass and cardiac arrest, we performed mitral valve replacement with a 27mm SJM mechanical valve.
PCPS was continued after surgical treatment because of pulmonary congestion.
Since the patient's circulation and respiratory function improved, PCPS and IABP were removed on postoperative days 3 and 5.
However, after removal of IABP, ventricular tachycardia appeared and IABP, PCPS were re-inserted.
After adequate medication with Amiodarone and Carbedirol, ventricular tachycardia was controlled.
PCPS and IABP were then removed uneventfully on postoperative days 14 and 19.
《19》血栓溶解療法時に経皮的心肺装置を用いた急性広汎型肺塞栓症の1例
Thrombolytic therapy for acute massive pulmonary embolism with the aid of a percutaneous cardiopulmonary support system
日本救急医学会誌Vol.4(1993)No.2 p148-152
https://www.jstage.jst.go.jp/article/jjaam1990/4/2/4_2_148/_pdf
A 65-year-old male was transferred to our medical center because of circulatory shock from suspected acute myocardial infarction.
The coronary angiogram findings, however, were normal.
Subsequently, cyanosis and hypotension became worse despite inhalation of enriched oxygen and injection of high doses of dopamine.
The pulmonary arterial pressure (68/38mmHg) was almost the same as the systemic blood pressure.
Using a percutaneous cardiopulmonary support system (PCPS) and artificial ventilation, pulmonary angiography was performed, and showed vascular cutoff and filling defects in more than 4 lobar arteries due to thromboemboli.
Tissuetype plasminogen activator (t-PA) was administered intravenously 6 and a half hours after the onset of symptoms at a dose of 1.6 million IU over one hour, followed by 3.2 million IU/day into the pulmonary artery for 3 consecutive days.
After 8 hours of t-PA therapy, a rapid reduction in the abnormally elevated right heart pressure was observed, and we were able to wean the patient off medication.
The patient subsequently recovered without any complications from the PCPS.
Thus temporary emergency use of PCPS until thrombolysis and recanalization of the obstructed pulmonary vascular beds could be achieved was helpful in preserving both systemic circulation and oxygenation of vital organs, and may increase the likelihood of survival in patients with acute massive pulmonary embolism.
《20》右室梗塞と脂肪塞栓症候群の合併に伴う呼吸循環不全に対しPCPSが奏功した1例
A case report of respiratory and circulatory failure complicated with fat embolism syndrome associated with right venticular infarction,which successfully treated by percutaneous
心臓Vol.34(2002)No.10 p.791-795
https://www.jstage.jst.go.jp/article/shinzo1969/34/10/34_791/_pdf
《21》経皮的心肺補助装置を用いて救命した薬剤ショックによるDOAの1例
Cardiac arrest due to anaphylactic shock successfully treated with percutaneuos cardio pulmonary support system
日本救急医学会誌Vol.5(1994)No.1p56-62
https://www.jstage.jst.go.jp/article/jjaam1990/5/1/5_1_56/_pdf
A 49-year-old man went into deep shock soon after an intravenous injection of Neurotropin and was referred to our medical center.
He developed cardiac arrest in the ambulance about 7 minutes before arriving at our center.
Cardio pulmonary resuscitation was performed for about an hour in the emergency room, but ventricular fibrillation (VF) was sustained.
The emergency percutaneous cardio pulmonary support system (PCPS) successfully resuscitated the patient and maintained general circulation.
The refractory VF indicated the presense of ischemic heart disease.
Coronary angiography (CAG) under PCPS support showed a marked spasm on the proximal site of the coronary arteries.
We suggest that the refractory VF was related to the coronary spasm induced by anaphylactic reaction.
He was soon weaned from PCPS and discharged without any remaining neurological deficits.
Emergency application of PCPS could improve the survival of cardiac arrest.
《22》非手術症例に対するPCPSによる長時間VAバイパスの適応と問題点
Percutaneous cardiopulmonary support for patients with acute circulatory failure
人工臓器VoL.27(1998)No.1 p147-149
https://www.jstage.jst.go.jp/article/jsao1972/27/1/27_1_144/_pdf
Circulatory assist using a percutaneous cardiopulmonary support system (PCPS) was performed in 5 patients with non-surgical cardiogenic shock over the past 6 years.
Their diagnoses were 3 cases of dilated cardiomyopathy (DCM), 1 acute myocardial infarction (AMI), and 1 acute myocarditis.
The causes of circulatory assist were 4 cases of severe arrythmia, such as ventricular tachycardia (VT) and ventricular fibrillation (Vf).
Survival rate was 20％ (1/5); the cause of death in 4 cases was multiple organ failure (MOF).
Parameters of renal and liver function during circulatory assist using PCPS were elevated from 3 days after starting circulatory assist.
Platelet count was also decreased from 3 days after starting circulatory assist.
Therefore, we think that the use of a ventricular support system as a mechanical bridge for cardiac transplantation should be considered at the stage when signs of MOF are absent while the patient is receiving temporary veno-arterial bypass (VAB).
《23》経皮的心肺補助装置(PCPS)が有効であった重症偶発性低体温症の1例
JJAAM 1998;9:256-260
https://www.jstage.jst.go.jp/article/jjaam1990/9/6/9_6_256/_pdf
Treatment of severe accidental hypothermia is still controversial.
We had a 41-year-old-male patient whose tympanic temperature was 25℃.
On arrival in our department, neurological findings showed a total of seven points at Glasgow Coma Scale, and bilateral fixed and dilated pupils.
An electrocardiogram revealed sinus bradycardia with multifocal ventricular prematube beats.
Rewarming trials by standard techniques neither increased the core temperature nor stabilized the circulation.
A percutaneous cardiopulmonary support system (PCPS) was initiated with a femoral bypass two hours after his arrival.
Both arterial and venous lines were immersed in warmed fluids.
PCPS was controlled at a three-liters per minute flow rate for four hours until the core temperature rose to 33.1℃.
After termination of PCPS, dopamine was easily removed.
The patient was discharged 10 days after admission without any neurological deficits.
In severe hypothermia, ventricular dysrhythmia is one of the most life-threatening complications.
Cardiopulmonary bypass (CPB) is characterized as the fastest method on rewarming and as the best choice in cardiac-arrested patients with severe hypothermia.
In comparison with CPB, PCPS can shorten preparatory time as well as decrease the number of staff members and medical expense.
PCPS should be applied not only for arrested patients but also for non-arrested patients with severe hypothermia, who have a high risk of circulatory collapse.
A case of fulminant myocarditis with varied sequentilal changes of ECGs, whose life has not been saved despite of intensive therapies such as PCPS
心臓VoL.41 suppl.3 (2009)
https://www.jstage.jst.go.jp/article/shinzo/41/SUPPL.3/41_S3_69/_pdf
･･･････････
急性心筋梗塞のPCI施行後96時間以内にスタチン剤投与すると重篤な心血管大イベントが67％減少した、特に不安定狭心症を減らした。との報告あり
↓スタチン剤の横紋筋融解症には心筋の壊死の場合もあるので一応
平成21年度 薬剤疫学的手法を利用した医薬品適正使用 p2より～スタチン剤
http://www.jshp.or.jp/gakujyutu/houkoku/h21gaku2.pdf
p11より～
http://www.mhlw.go.jp/shingi/2006/10/dl/s1019-4d8.pdf
以前、リピトール（上記《11》のアトルバスタチン）を数日服用し右下腿の激痛→横紋筋融解症→内反尖足の変形拘縮→杖歩行、の30歳台前半の人がいました。リピトールが原因と書いたのは本人が右足激痛で病院に電話したところリピトールの中止を言われたとのこと。
30歳前半なのですがⅡ型で、インスリン60単位以上（Ⅰ型ではなく）の人でした（治療は全額公費のかた）血糖コントロールが大変だった人でしょうか。その60単位以上の人は○正施設入所後、半年でインスリン8単位になりました（8単位は実質、経口薬オンリーになる時期。8単位でも低血糖（インスリン治療してる人は歩行しただけで低血糖になることがあり歩行するとインスリン必要量が減る（←歩行は大きな筋、大腿四頭筋と大殿筋が収縮するから））
半年で8単位に減るのは嘘だと思いますか？居室から工場へ移動時にフラフラして時間がかかる、転倒した、と診察室に連れてこられる→低血糖、インスリン単位減量→毎日診察室で測ってもらい毎日単位減量→8単位になり非常勤Drの診察順番へ（経口薬オンリーにならないで8単位が続いてました）
･･････････････････
wikiより引用開始
急性心筋炎は、無症状の場合もあるが、多くは感冒様症状 (かぜ症候群) や消化器症状などの前駆症状を伴う。前駆症状の1～2週間後に、胸痛、心不全症状、ショック、不整脈などの症状を呈する。
上述のとおり、心筋炎は特徴的な所見に乏しい疾患であるが、かろうじて特徴を見いだせるのが心電図である。心筋炎の急性期には、ほとんどの症例で完全房室ブロック（Ⅱ, Ⅲ度）、陰性T波、ST変化、心室性期外収縮（PVC）などの異常が見られる。また、これらに比べると稀ではあるが、心室頻拍（VT）、異常Q波、心房細動（AF）などが見られることもある。
非特異的ST変化はほぼ全例に認められる。R波減衰、異常Q波は、ほぼ半数に認められる。
また、心筋細胞の障害をきたすことから、一般生化学検査においては心筋逸脱酵素（CPK, AST, LDH）が上昇する。トロポニンTは迅速診断キットがあり、早期から異常を呈し、心筋特異的物質であることから、診断に特に有用である。BNP,NT-proBNPは心機能の把握に有用である。
心エコーでは、軽度の内腔拡大と心膜液貯留のほか、左室の壁運動低下と駆出率の著明な低下、壁肥厚などが認められる。
治療 現在はそれぞれのウイルスに対しては抗ウイルス薬を投与する他には、対症療法(PCPSや利尿剤など)とステロイド・γグロブリン投与しか選択肢がない状況である。
引用終わり
･･････････････････
《12》インフルエンザA型ウイルスによる劇症型心筋炎の1剖検例
A case of fluminant myocarditis caused by influenza A virus
心臓Vol,32(2000)No.2p.102-106
https://www.jstage.jst.go.jp/article/shinzo1969/32/2/32_102/_pdf
《13》新型インフルエンザA/H1N1に合併した劇症型心筋炎に経皮的心肺補助PCPSを導入し救命した一例
A patient who survived 2009 influenza A/H1N1-associated fulminant myocarditis with percutaneous cardiopulmonary support（PCPS）
日救急医会誌.2010;21:804-810
https://www.jstage.jst.go.jp/article/jjaam/21/9/21_9_804/_pdf
We describe a patient who survived 2009 influenza A/H1N1-associated fulminant myocarditis with critical care including percutaneous cardiopulmonary support (PCPS).
A 24-year-old female was diagnosed in November 2009 with influenza A and received oseltamivir.
Although her fever decreased, she experienced frequent vomiting and diarrhea 5 days after disease onset and was transfered to our hospital the following day.
Electrocardiograms showed ST-segment elevation in leads Ⅱ, Ⅲ, aVf, and V3-6, with increase in creatine kinase and troponin T levels.
Cardiac ultrasonography revealed marked overall reduction of wall motion, establishing a diagnosis of myocarditis.
Following ICU admission, general management was provided by intraaortic balloon pumping (IABP) with catecholamines, with continuous homodiafiltration (CHDF) to address acute renal failure.
Next morning, cardiopulmonary arrest was happened and PCPS was initiated.
Following PCPS circuit replacement on day 4, cardiac function gradually improved till weaning from both PCPS and IABP on day 7 and CHDF on day 8.
Prolonged mechanical ventilation due to airway hemorrhage and left pulmonary atelectasis ended with tracheal tube removal on day 15.
She was discharged without neurological sequelae on day 33.
PCPS, initiated without delay upon in-hospital cardiopulmonary arrest, enabled her survival with standard supportive care alone.
《14》健康診断の心電図にて変動が認められた突然死の症例
A case of sudden cardiac death with rapid progression of deterioration of heart function, unknown etiology and ventricular fibrilation
心臓Vol.40(2008)No.Supple3 p.21-28
https://www.jstage.jst.go.jp/article/shinzo1969/40/Supplement3/40_17/_pdf
《15》健診心電図異常でみつかった両心房内巨大粘液腫の1例
A case of biatrial giant myxoma revealed by EKG abnormality on annual medical examination
心臓Vol.38(2006)No.9 p.935-941
https://www.jstage.jst.go.jp/article/shinzo1969/38/9/38_935/_pdf
《16》循環不全を呈した診断のついていない白血病患者に経皮的心肺補助装置を導入した症例
A case of irreverently applied PCPS in an undiagnosed leukemia patient who developed cardiopulmonary collapse
日本集中治療医学会誌Vol.10 (2003) No.4 p347-351
https://www.jstage.jst.go.jp/article/jsicm1994/10/4/10_4_347/_pdf
A 44 year-old man was refered to the ICU for his sudden and severe dyspnea.
His physical findings, chest radiograph, and ECG suggested acute pulmonary thromboembolism.
Although his trachea was intubated due to severe hypoxemia and rapidly progressing conscious disturbance, it did not improved hypoxemia and, worse than that, induced sudden hypotention and pulmonary arterial congestion.
None of medical treatments like inotropes including epinephrine, fluid administration, and mechanical ventilation did not improve his condition and we started emergent percutaneous cardiopulmonary support system (PCPS) to prevent circulatory collapse and probable death.
PCPS raised his systolic blood pressure from 70mmHg to 100mmHg.
We found hepatosplenomegaly after the beginning of PCPS by palpating his distended abdomen.
Emergent pulmonary angiography showed multiple filling defects in the distal pulmonary arteries.
Continuous hemodiafiltration (CHDF) was carried out for acute renal failure presenting anuria, hyperkalemia, and metabolic acidosis.
Subsequent laboratory findings suggested acute crisis of chronic myelogenic leukemia as his background and we considered that pulmonary thromboembolism had resulted from hyperleukocytosis and hyperthrombocytosis.
PCPS was discontinued six hours after the initiation because of gradual occlusion of artificial lung membrane and finally the patient lost his life.
Autopsy revealed extensive infiltration of chronic myelocytic leukemic cells in major organs including both lungs.
The final diagnosis is pulmonary thromboembolism by blastic crisis of chronic myelocytic leukemia and it is retrospectively non-indicative for PCPS.
This case highlights the clinical, radiographic and histolic features of pulmonary leukostasis and reminds us that it is difficult to exclude fatal malignant diseases during resuscitation.
《17》壊死性好酸球性心筋炎の1剖検例
An autopy case of necrotizing eosinophilic myocarditis
心臓Vol.35 No.8(2003)
https://www.jstage.jst.go.jp/article/shinzo1969/35/8/35_581/_pdf
《18》術後心室頻拍に対し長期補助循環が有用であった心筋梗塞後乳頭筋断裂の1例
Surgical treatment for papillary muscle rupture after myocardial infarction with sustained ventricular tachycardia
日本心臓血管外科会誌Vol.37(2008)No.2p.140-143
https://www.jstage.jst.go.jp/article/jjcvs/37/2/37_2_140/_pdf
We report an operative case of papillary muscle rupture after myocardial infarction with sustained ventricular tachycardia.
A 56-year-old man referred to our emergency room in shock.
Emergency CAG showed total occlusion of the left circumflex artery, in which we placed a metallic stent.
Even after re-canalization of the coronary artery was achieved, circulation was unstable.
IABP and PCPS were used to maintain the systemic circulation.
Trans-esophageal echocardiography showed papillary muscle rupture and massive mitral regurgitation.
Under total cardiopulmonary bypass and cardiac arrest, we performed mitral valve replacement with a 27mm SJM mechanical valve.
PCPS was continued after surgical treatment because of pulmonary congestion.
Since the patient's circulation and respiratory function improved, PCPS and IABP were removed on postoperative days 3 and 5.
However, after removal of IABP, ventricular tachycardia appeared and IABP, PCPS were re-inserted.
After adequate medication with Amiodarone and Carbedirol, ventricular tachycardia was controlled.
PCPS and IABP were then removed uneventfully on postoperative days 14 and 19.
《19》血栓溶解療法時に経皮的心肺装置を用いた急性広汎型肺塞栓症の1例
Thrombolytic therapy for acute massive pulmonary embolism with the aid of a percutaneous cardiopulmonary support system
日本救急医学会誌Vol.4(1993)No.2 p148-152
https://www.jstage.jst.go.jp/article/jjaam1990/4/2/4_2_148/_pdf
A 65-year-old male was transferred to our medical center because of circulatory shock from suspected acute myocardial infarction.
The coronary angiogram findings, however, were normal.
Subsequently, cyanosis and hypotension became worse despite inhalation of enriched oxygen and injection of high doses of dopamine.
The pulmonary arterial pressure (68/38mmHg) was almost the same as the systemic blood pressure.
Using a percutaneous cardiopulmonary support system (PCPS) and artificial ventilation, pulmonary angiography was performed, and showed vascular cutoff and filling defects in more than 4 lobar arteries due to thromboemboli.
Tissuetype plasminogen activator (t-PA) was administered intravenously 6 and a half hours after the onset of symptoms at a dose of 1.6 million IU over one hour, followed by 3.2 million IU/day into the pulmonary artery for 3 consecutive days.
After 8 hours of t-PA therapy, a rapid reduction in the abnormally elevated right heart pressure was observed, and we were able to wean the patient off medication.
The patient subsequently recovered without any complications from the PCPS.
Thus temporary emergency use of PCPS until thrombolysis and recanalization of the obstructed pulmonary vascular beds could be achieved was helpful in preserving both systemic circulation and oxygenation of vital organs, and may increase the likelihood of survival in patients with acute massive pulmonary embolism.
《20》右室梗塞と脂肪塞栓症候群の合併に伴う呼吸循環不全に対しPCPSが奏功した1例
A case report of respiratory and circulatory failure complicated with fat embolism syndrome associated with right venticular infarction,which successfully treated by percutaneous
心臓Vol.34(2002)No.10 p.791-795
https://www.jstage.jst.go.jp/article/shinzo1969/34/10/34_791/_pdf
《21》経皮的心肺補助装置を用いて救命した薬剤ショックによるDOAの1例
Cardiac arrest due to anaphylactic shock successfully treated with percutaneuos cardio pulmonary support system
日本救急医学会誌Vol.5(1994)No.1p56-62
https://www.jstage.jst.go.jp/article/jjaam1990/5/1/5_1_56/_pdf
A 49-year-old man went into deep shock soon after an intravenous injection of Neurotropin and was referred to our medical center.
He developed cardiac arrest in the ambulance about 7 minutes before arriving at our center.
Cardio pulmonary resuscitation was performed for about an hour in the emergency room, but ventricular fibrillation (VF) was sustained.
The emergency percutaneous cardio pulmonary support system (PCPS) successfully resuscitated the patient and maintained general circulation.
The refractory VF indicated the presense of ischemic heart disease.
Coronary angiography (CAG) under PCPS support showed a marked spasm on the proximal site of the coronary arteries.
We suggest that the refractory VF was related to the coronary spasm induced by anaphylactic reaction.
He was soon weaned from PCPS and discharged without any remaining neurological deficits.
Emergency application of PCPS could improve the survival of cardiac arrest.
《22》非手術症例に対するPCPSによる長時間VAバイパスの適応と問題点
Percutaneous cardiopulmonary support for patients with acute circulatory failure
人工臓器VoL.27(1998)No.1 p147-149
https://www.jstage.jst.go.jp/article/jsao1972/27/1/27_1_144/_pdf
Circulatory assist using a percutaneous cardiopulmonary support system (PCPS) was performed in 5 patients with non-surgical cardiogenic shock over the past 6 years.
Their diagnoses were 3 cases of dilated cardiomyopathy (DCM), 1 acute myocardial infarction (AMI), and 1 acute myocarditis.
The causes of circulatory assist were 4 cases of severe arrythmia, such as ventricular tachycardia (VT) and ventricular fibrillation (Vf).
Survival rate was 20％ (1/5); the cause of death in 4 cases was multiple organ failure (MOF).
Parameters of renal and liver function during circulatory assist using PCPS were elevated from 3 days after starting circulatory assist.
Platelet count was also decreased from 3 days after starting circulatory assist.
Therefore, we think that the use of a ventricular support system as a mechanical bridge for cardiac transplantation should be considered at the stage when signs of MOF are absent while the patient is receiving temporary veno-arterial bypass (VAB).
《23》経皮的心肺補助装置(PCPS)が有効であった重症偶発性低体温症の1例
JJAAM 1998;9:256-260
https://www.jstage.jst.go.jp/article/jjaam1990/9/6/9_6_256/_pdf
Treatment of severe accidental hypothermia is still controversial.
We had a 41-year-old-male patient whose tympanic temperature was 25℃.
On arrival in our department, neurological findings showed a total of seven points at Glasgow Coma Scale, and bilateral fixed and dilated pupils.
An electrocardiogram revealed sinus bradycardia with multifocal ventricular prematube beats.
Rewarming trials by standard techniques neither increased the core temperature nor stabilized the circulation.
A percutaneous cardiopulmonary support system (PCPS) was initiated with a femoral bypass two hours after his arrival.
Both arterial and venous lines were immersed in warmed fluids.
PCPS was controlled at a three-liters per minute flow rate for four hours until the core temperature rose to 33.1℃.
After termination of PCPS, dopamine was easily removed.
The patient was discharged 10 days after admission without any neurological deficits.
In severe hypothermia, ventricular dysrhythmia is one of the most life-threatening complications.
Cardiopulmonary bypass (CPB) is characterized as the fastest method on rewarming and as the best choice in cardiac-arrested patients with severe hypothermia.
In comparison with CPB, PCPS can shorten preparatory time as well as decrease the number of staff members and medical expense.
PCPS should be applied not only for arrested patients but also for non-arrested patients with severe hypothermia, who have a high risk of circulatory collapse.