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���� ����������Vol. 32, pp. 181�187, 2004

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�����: �� 154 cm� �� 64 kg �Body massindex; BMI 27�, ����� ��� 50 mmHg

� ��� �� 80 ���� 7 L�������������������� 80� ��� � !�"�#�$%&'()*� � +,���-./&'( �0��1)2� 3�4'()*� ����: �56�#78��� D-9��:�;<� =���>&'( �Table. 1��

!�?@AB@: CD��EFG H&'( �Fig. 1��

����: I�6 83 ����JK�� III� V1�2�L�MG TN&'( �Fig. 2��

�����: IOPQ�RSGT�8CO�U,&'( ������: VWXYZ[.\�� 0]^�A?:_@`&ab2 c\��de8� fg)=���=���>&'(� Ihi:�CIj�U,&'( e8kl A-PTE &m� � n��op�q4rs2� ��t uv�)w)� (xyz{y�ID|} �Cardiopulmonary Resuscitation; CPR�&ab2 � � 30 �~� CPR ����t)� (� 11� 20������ PCPS &ab2 � +,���kl 15�?@�����_�:?� C,�3�kl 21 �?@�����_�:?&{�2�PCPS �T�&ab2 � PCPS ����82�������������� EBS ����� ��4� EBS ID��A&��2 � 2*2��t����l� CPR &�a2� PCPS 4��t��)2800��� I�v�82� 1.5 L�min�ab2 �!� CT��CD������� �¡8+D���#�0�¢��£&'( �Fig. 3�� �� CT �PCPS ����_�:?t+¤3��{�¥¦�§l� ¤¨©��1&ª«2�� t� ¬­®��y¯�v4'()*� � °�\� E±0����_�:?&CI���{�2 � °�c\kl1100 ���I�v�82� 1.9 L�min ²�³de8tv� � A-PTE �´2µ+,�3�� 5�?@�� pig tail ��:��� 8�?@�� 90 cm �

Fig. 2. The electrocardiogram demonstrated sinus rhy-

thm with inderted T wave in leads III� V1�2.

Fig. 1. Chest radiography demonstrating a Cardio-thor-

acic ratio of 61.8� and hyperlucent area in rightlung field and PCPS[s cannula in right atrium�

Table. 1. Laboratory Data

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������������ ������� ����������� Pro-UK ��������4500 IU� � ����� !�����"#$���%� ������&���'(�Fig. 4�� ���� )*+�,����-.��/01����2��#����� ���16 �3�� 4.8 L���4(� � 23 ��5678 9:!�� PCPS � 24 ;<="#"#$�>-$(� #�� %)*+�,�&?5@A'��4(� PCPS B�(��C@�D)E5�'F04(� A-PTE �G*+,�('� �-�H�

Gunther H.-�IJ�K�����(� �� CT�����2�/L��'F04(('MNO��P012�QR�� S3TU;< �activated clot-ting time; ACT� 5 2004�56�(� 24��57VW�X019"#�� 25 �018>Y9FZ:�F4(('� MNO��P01201[�I\O��8]^��(�2004 ; 1 _ 7 ��`� CT =!���(H<a

��5b����(>� *E=��>c�?@F&���'(� Hd-�AeBfg=h.�-�����'(� �ij25kfgl� �m9no5�'F�('pqrs��(� 1_ 8�� C�OtuOv��w��D'��Ex@A�FA�F4(�

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Gy=� A-PTE �;<*HI5 50�60 J7�z{� ��|}� 10�5*E 1;<C�~K"#��{��#4� 5�� �(�L=�*HI5Gy�1�50���1{��#1�� ��5� �����E�������'��>�l���#2���9�� ��.�M�����*N�O��*E� A-PTE>/����#3�� �:� ��6P����Q3RS��T��#U�-��E �Deep VenousThrombus; DVT� �+,��4(�900�1��A-PTE �*E�(EV�p��(� LEV�� L���WX1�CH���� �s"#�� DVT ��������� ���� ���� PTE ���A-PTE 5YA��V� 0.03��0.09���'1{#6�7�� ZM'�5[ F�9��� *E�(¡D�5\]'�F%|#('� ^¢=£F�D)E=�#� A-PTE � 90�Cl5Hd� DVT >¤�¥���1{��%8�9�� DVT �_¦`a>.b=�#� §c'� DVT �`a5d¨EZ�2e� ©5�fª� �g�=«�{�� ¬h`a���*­z{#$�>[�� DVT �fg����5 � -�i® � AeBfg �� �Bfg �� 3D-CT � MRV >¯�1{#� AeBfg5i®°F±��T"#jk>F�('l²³'���#>� fg�5´m�k�nTª>o{��#µZ>�#10�� Cl��p"#� golden standard �z{#-�i®� �� Hd-� CT��#q¶>rT�·�{#� �EV����5� ¸¹��3-�º��'

Fig. 3. Chest computed tomography showing total oc-

clusion of right main pulmonary artery and

thrombus in superior lobe� inferior lobe of leftpulmonary artery�

Fig. 4. Pulmonary angiography demonstrated reperfu-

sion of right main pulmonary artery�

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��DVT� ��������DVT������� DVT ������������� ��� ���� DVT ������� DVT ��A-PTE �������������� ��������� ��� ������ DVT �������������!������DVT ����"�� 2001 ��� 6 # ACCP

�American College of Chest Physicians ConsensusStatement� �$���11�� ����%�&'(�)�*�� ����+������ ���� ���,���� �-�� .!/"�#0�-����,��123425�6�77���.!��8� 9$���� 6���� :;�%<&=&��'()*<&��)*<&=&����123425�>+��12�� ��?�123425 ACCP�123425�,@���� 1� -.��%�&'(/)� 1�2/)0A1������� 2� 2<�B3��C4���#5����6DEFG�H&'(�G78������ 3� ,�����9:���0!;<�IJK&5 =L>M�������78������� �N�-��?O��� 8�123425�@FP� Q"A.R� &'(STU���H&'(��B��� VWXYZC� �intermittent pneumatic compression; IPC���� 0!;<�IJK&5�78���� ������� D�EF�.!����� [\� DVT ��� G/"��� D�EF�WH���� ]^I���ZCZ�_��8�� `Vab�� �ZCZ�0;��8���cG��� ���� 8����8��"J�/"�����D�EF DVT ������� G������dFG��KeG fg���� A-PTE ��fL���� A-PTE �:%Mh �Cardiopulmonary arrest;CPA� �ijk(������N��Ol����13�� ����PQ� PCPS ���RmST����� A-PTE �bn�Ol14�� � ��oN��p�UqrV������ ?s Wt� A-PTE �Xu�� DVT �u2Y 50����Ol����15�� 8�8� � '()*�v+��Z[<& � �'()*�G\]�� 6����wx�Rmy^�z{�8��dFG��� ��� �p�v+��/"����� _`� DVTa+�����{/"�����dFG��

� PTE ����������� ��� � ����A-PTE �bc � Z�<&v+�������JK&516��<&�d|�e�� urokinase�fg}4'~���5�(�T�� �tissue plas-minogen activator;t-PA� �N���<&d|c���h����17�� ���ijk(�i�����a���\ Gj��8����� �kp�tl�N� A-PTE � � ���mq�w�Rmy^�G]^�����n����18�� �p�2<�B3����<&d|c��.!�o���������� <&��c��p�c� �!���19�20��������� PCPS �^<����S���qrs��� a)*<&d|c� ^F��� ���� <&���� p������ �mq�%t*<u���v�wG�� mq�Rmtx��y��dFG�� 7� 2 z������IVC filter ���� � ��� A-PTE ��NA� 7���� qrs��8�� �p����c�9h d{��|�������}.��� ��� A-PTE ���� PCPS �������������A-PTE �tl� 10��G 33� � 1`V�L����������1�5�21�� Rm���^���G~����� bc�n����� ���� �p 1 `V� PCPS ���� STRm����8��p���A ��¡�¢�/"��� A-PTE �a�� PCPS �]^£���� �h� � ���� v�������¤�¥� ¦�RmG��G/§����� x������ ����/"����8��N��cG��22��27�� A-PTE���w�RmG� %t*��=���¨:�©� ª:«�y^���� PCPS �¨K�G^<��t*¬��< <^tx� �!���� ­��®��%�bc�/"�� bcp�RmG���y�¯G���GP� 6�V����Rm� PCPS�ST��8����°� /"����� PCPS � !"�#$%�PCPS ±²¡��?�5³�´� � PCPS ��

�B3� 2<� <&=&����28�� PCPS ���` µw-.���� t�)*�����S�����¶�·�(� p��¸¬�2<� <¹rs�3��8��N�� 7 PCPS º^9 ���

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24� �VWX� YZ[C� )1!\]"#$%�N)1^�N_KL�!`a� bcd 2002; 51:329�332�

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Abstract

Successfully Resuscitated Case of Acute Pulmonary Embolism after

Hip Replacement Arthroplasty Operation.

Osamu Miyazu1, Masahiro Yamauchi1, Yoshiyuki Watanabe1, Masato Uno1, Atsushi Seki1,

Masayoshi Sakakibara1, Naoki Matsumoto2, Kiyoshi Nakazawa1, Fumihiko Miyake1,

Hiroshi Murakami3 and Haruo Makuuchi3.

Total hip replacement operation had been performed for sixty-two year-old female on Dec. 9th, 2003.

Post operative status had been stable until she developed sudden circulatory collapse after chest pain and

dyspnea on 22nd. Suspecting acute pulmonary embolism, percutaneous cardiopulmonary support system

�PCPS� was introduced after unsuccessful resuscitaion. Thromboembolic occlusions in the right mainpulmonary artery and upper�lower branch of the left pulmonary artery were demonstrated by pulmonaryarteriography. Clot-busting and aspiration therapy were attempted resulting in recovery of pulmonary blood

flow. Spontaneous heart beats and circulation resumed in 24 hours, and PCPS was successfully removed. No

complications occurred and she has completely rehabilitated to ordinary social life activities. PCPS was

found to be a useful method to support circulatory distress in serious acute pulmonary embolism.

1 Division of Cardiology, Department of Internal Medicine

2 Department of Pharmacology

3 Division of Cardiovascular Surgery, Department of Surgery St. Marianna University School of Medicine.

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