心肺复苏并发冠状动脉破裂及迟发性肝破裂一例并文献复习_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

陈强 , 张洁 , 林志敏 , 桑岭 , 黎毅敏 , 刘晓青 ,  徐远达

广州医科大学附属第一医院呼吸疾病国家重点实验室广州呼吸健康研究院呼吸与危重症医学科（广东广州 510120）;

Corresponding author：

徐远达, Email: xuyuanda@sina.com

Keywords：

心肺复苏; 冠状动脉破裂; 肝破裂

DOI：

10.7507/1671-6205.202007081

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目的总结分析心肺复苏（CPR）患者的近期与远期并发症。方法对 1 例肺癌术后 CPR 并发冠状动脉及迟发性肝破裂患者的临床资料，结合文献复习进行分析。总结其临床特点，诊治方案与预后。结果患者女，66 岁，左肺腺癌（T_1bN₀M₀，Ia 期），行左上肺肺癌根治术，术后 13 h 突发心跳骤停，给予 CPR 2 h，期间出现失血性休克，床边开胸探查，发现冠状动脉左前降支有一破损口；CPR 后第 12 天，再次失血性休克，腹部超声：肝脏破裂出血，予内科保守治疗后，出血吸收。术后 3 个月，神志恢复，格拉斯哥昏迷量表评分 9 分，转下级医院继续康复。文献检索后经筛选剔除，共检索到相关文献 14 篇。35 例冠状动脉破裂（尸体解剖回顾性研究）、34 例肝破裂（个案报道）。肝破裂病死率高达 70.6%。左肝比右肝破裂多，大部分通过 CT/超声诊断。治疗上包括手术、保守、肝动脉栓塞。结论 CPR 合并冠状动脉、肝破裂患者，起病急，病死率高。临床上需警惕、避免、甄别 CPR 并发症，做到早诊断、早治疗。

Citation： 陈强, 张洁, 林志敏, 桑岭, 黎毅敏, 刘晓青, 徐远达. 心肺复苏并发冠状动脉破裂及迟发性肝破裂一例并文献复习. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(3): 209-214. doi: 10.7507/1671-6205.202007081 Copy

1.	Buschmann CT, Tsokos M. Frequent and rare complications of resuscitation attempts. Intensive Care Med, 2009, 35(3): 397-404.
2.	崔金鹏, 霍学军, 赵金钊, 等. 胸外按压致肝破裂 2 例的救治体会. 中国现代普通外科进展, 2013, 16(11): 921-922.
3.	Beydilli H, Balci Y, Erbas M, et al. Liver laceration related to cardiopulmonary resuscitation. Turk J Emerg Med, 2016, 16(2): 77-79.
4.	Meron G, Kurkciyan I, Sterz F, et al. Cardiopulmonary resuscitation-associated major liver injury. Resuscitation, 2007, 75(3): 445-453.
5.	Zahn G, Hauck M, Pearson DA, et al. Major hemorrhage from hepatic laceration after cardiopulmonary resuscitation. Am J Emerg Med, 2015, 33(7): 991. e3-e4.
6.	Lundqvist J, Jakobsson JG. Pulmonary emboli cardiac arrest with CPR complication: Liver laceration and massive abdominal bleed, a case report. Int J Surg Case Rep, 2017, 31: 24-26.
7.	Salzman M, Friedman J. Bystander cardiopulmonary resuscitation-induced splenic laceration and hepatosplenic hematoma. Am J Emerg Med, 2012, 30(2): 388. e1-e2.
8.	Cox TR, Crimmins SD, Shannon AM, et al. Liver lacerations as a complication of CPR during pregnancy. Resuscitation, 2018, 122: 121-125.
9.	Camden JR, Carucci LR. Liver injury diagnosed on computed tomography after use of an automated cardiopulmonary resuscitation device. Emerg Radiol, 2011, 18(5): 429-431.
10.	Koutserimpas C, Ioannidis A, Siaperas P, et al. Intra-abdominal hemorrhage following cardiopulmonary resuscitation: a report of two cases. Case Rep Emerg Med, 2018, 2018: 5243105.
11.	Juan YH, Saboo SS, Desai NS, et al. Aortic intramural hematoma and hepatic artery pseudoaneurysm: unusual complication following resuscitation. Am J Emerg Med, 2014, 32(1): 107. e1-e4.
12.	Drew T, Blackstock A, Aron J. Lund University Cardiac Assist System induced liver laceration and anterior cord infarction after cardiac arrest: a case report. A A Pract, 2020, 14(3): 79-82.
13.	Sertic F, Bosco P, Ferrara A, et al. ICD lead extraction: not a benign procedure. External chest compression: not a benign manoeuvre. JRSM Cardiovasc Dis, 2017, 6: 2048004017731040.
14.	Lau G. A case of sudden maternal death associated with resuscitative liver injury. Forensic Sci Int, 1994, 67(2): 127-132.
15.	Adler SN, Klein RA, Pellecchia C, et al. Massive hepatic hemorrhage associated with cardiopulmonary resuscitation. Arch Intern Med, 1983, 143(4): 813-814.
16.	Krischer JP, Fine EG, Davis JH, et al. Complications of cardiac resuscitation. Am Heart J, 1987, 92(2): 287-291.
17.	Fordyce CB, Katz JN, Alviar CL, et al. Prevention of complications in the cardiac intensive care unit: A Scientific Statement From the American Heart Association. Circulation, 2020, 142(22): e379-e406.
18.	Frink RJ, Rose JP. Cardiopulmonary resuscitation and direct cardiac injury: evidence of fractured coronary arteries and HIS bundle hemorrhage. J Invasive Cardiol, 1997, 9(9): 578-585.
19.	王殿深, 张付, 孟运乐, 等. 钝性暴力、心肺复苏、急性心梗致心脏破裂及主动脉夹层破裂致心包填塞法医病理形态学特点. 南方医科大学学报, 2018, 38(12): 120-126.
20.	Tattoli L, Maselli E, Romanelli MC, et al. Complete cardiac rupture associated with closed chest cardiac massage: case report and review of the literature. J Forensic Sci, 2014, 59(2): 564-567.
21.	Kurkciyan I, Meron G, Sterz F, et al. Major bleeding complications after cardiopulmonary resuscitation: Impact of thrombolytic treatment. J Intern Med, 2003, 253(2): 128-135.
22.	Javaudin F, Lascarrou JB, Esquina H, et al. Improving identification of pulmonary embolism-related out-of-hospital cardiac arrest to optimize thrombolytic therapy during resuscitation. Crit Care, 2019, 23(1): 409.
23.	Hashimoto Y, Moriya F, Furumiya J. Forensic aspects of complications resulting from cardiopulmonary resuscitation. Leg Med (Tokyo), 2007, 9(2): 94-99.
24.	Sartorelli KH, Frumiento C, Rogers FB, et al. Nonoperative management of hepatic, splenic, and renal injuries in adults with multiple injuries. J Trauma, 2000, 49(1): 56-62.
25.	Streith L, Silverberg J, Kirkpatrick AW, et al. Optimal treatments for hepato-pancreato-biliary trauma in severely injured patients: a narrative scoping review. Can J Surg, 2020, 63(5): E431-E434.

1. Buschmann CT, Tsokos M. Frequent and rare complications of resuscitation attempts. Intensive Care Med, 2009, 35(3): 397-404.
2. 崔金鹏, 霍学军, 赵金钊, 等. 胸外按压致肝破裂 2 例的救治体会. 中国现代普通外科进展, 2013, 16(11): 921-922.
3. Beydilli H, Balci Y, Erbas M, et al. Liver laceration related to cardiopulmonary resuscitation. Turk J Emerg Med, 2016, 16(2): 77-79.
4. Meron G, Kurkciyan I, Sterz F, et al. Cardiopulmonary resuscitation-associated major liver injury. Resuscitation, 2007, 75(3): 445-453.
5. Zahn G, Hauck M, Pearson DA, et al. Major hemorrhage from hepatic laceration after cardiopulmonary resuscitation. Am J Emerg Med, 2015, 33(7): 991. e3-e4.
6. Lundqvist J, Jakobsson JG. Pulmonary emboli cardiac arrest with CPR complication: Liver laceration and massive abdominal bleed, a case report. Int J Surg Case Rep, 2017, 31: 24-26.
7. Salzman M, Friedman J. Bystander cardiopulmonary resuscitation-induced splenic laceration and hepatosplenic hematoma. Am J Emerg Med, 2012, 30(2): 388. e1-e2.
8. Cox TR, Crimmins SD, Shannon AM, et al. Liver lacerations as a complication of CPR during pregnancy. Resuscitation, 2018, 122: 121-125.
9. Camden JR, Carucci LR. Liver injury diagnosed on computed tomography after use of an automated cardiopulmonary resuscitation device. Emerg Radiol, 2011, 18(5): 429-431.
10. Koutserimpas C, Ioannidis A, Siaperas P, et al. Intra-abdominal hemorrhage following cardiopulmonary resuscitation: a report of two cases. Case Rep Emerg Med, 2018, 2018: 5243105.
11. Juan YH, Saboo SS, Desai NS, et al. Aortic intramural hematoma and hepatic artery pseudoaneurysm: unusual complication following resuscitation. Am J Emerg Med, 2014, 32(1): 107. e1-e4.
12. Drew T, Blackstock A, Aron J. Lund University Cardiac Assist System induced liver laceration and anterior cord infarction after cardiac arrest: a case report. A A Pract, 2020, 14(3): 79-82.
13. Sertic F, Bosco P, Ferrara A, et al. ICD lead extraction: not a benign procedure. External chest compression: not a benign manoeuvre. JRSM Cardiovasc Dis, 2017, 6: 2048004017731040.
14. Lau G. A case of sudden maternal death associated with resuscitative liver injury. Forensic Sci Int, 1994, 67(2): 127-132.
15. Adler SN, Klein RA, Pellecchia C, et al. Massive hepatic hemorrhage associated with cardiopulmonary resuscitation. Arch Intern Med, 1983, 143(4): 813-814.
16. Krischer JP, Fine EG, Davis JH, et al. Complications of cardiac resuscitation. Am Heart J, 1987, 92(2): 287-291.
17. Fordyce CB, Katz JN, Alviar CL, et al. Prevention of complications in the cardiac intensive care unit: A Scientific Statement From the American Heart Association. Circulation, 2020, 142(22): e379-e406.
18. Frink RJ, Rose JP. Cardiopulmonary resuscitation and direct cardiac injury: evidence of fractured coronary arteries and HIS bundle hemorrhage. J Invasive Cardiol, 1997, 9(9): 578-585.
19. 王殿深, 张付, 孟运乐, 等. 钝性暴力、心肺复苏、急性心梗致心脏破裂及主动脉夹层破裂致心包填塞法医病理形态学特点. 南方医科大学学报, 2018, 38(12): 120-126.
20. Tattoli L, Maselli E, Romanelli MC, et al. Complete cardiac rupture associated with closed chest cardiac massage: case report and review of the literature. J Forensic Sci, 2014, 59(2): 564-567.
21. Kurkciyan I, Meron G, Sterz F, et al. Major bleeding complications after cardiopulmonary resuscitation: Impact of thrombolytic treatment. J Intern Med, 2003, 253(2): 128-135.
22. Javaudin F, Lascarrou JB, Esquina H, et al. Improving identification of pulmonary embolism-related out-of-hospital cardiac arrest to optimize thrombolytic therapy during resuscitation. Crit Care, 2019, 23(1): 409.
23. Hashimoto Y, Moriya F, Furumiya J. Forensic aspects of complications resulting from cardiopulmonary resuscitation. Leg Med (Tokyo), 2007, 9(2): 94-99.
24. Sartorelli KH, Frumiento C, Rogers FB, et al. Nonoperative management of hepatic, splenic, and renal injuries in adults with multiple injuries. J Trauma, 2000, 49(1): 56-62.
25. Streith L, Silverberg J, Kirkpatrick AW, et al. Optimal treatments for hepato-pancreato-biliary trauma in severely injured patients: a narrative scoping review. Can J Surg, 2020, 63(5): E431-E434.

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心肺复苏并发冠状动脉破裂及迟发性肝破裂一例并文献复习

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