Gagal Napas Sebagai Gejala Awal Emboli Paru

Defri Aryu Dinata, Nurita Dian, Hori Hariyanto, Oloan Tampubolon

Abstract


Insidensi emboli paru (PE) sangat tinggi namun penegakan diagnosisnya sangat sulit dikarenakan gejala yang timbul pada setiap pasien sangat bervariasi. Terdapat tiga gambaran klinis PE, yaitu infark paru, dispnea akut yang tidak dapat dijelaskan, dan kor pulmonal akut. Pada kasus ini pasien mengalami dispnea akut yang tidak dapat dijelaskan penyebabnya. Pemeriksaan berupa foto thorak, elektrokardiografi dan ekokardiografi tidak menunjukan abnormalitas. Kecurigaan PE muncul ketika pasien mengalami syok refrakter selama tiga hari perawatan. Dilakukan CT–angiografi dan pasien terbukti mengalami trombosis pada arteri pulmonal kiri. Selanjutnya pasien menjalani percutaneus intraarterial trombolitic (PIAT) dengan rtPA. Terapi trombolisis ini gagal menghancurkan trombus, dikarenakan massa trombus yang besar dan terfiksir. Selanjutnya pasien direncanakan menjalani operasi pembedahan embolektomi, namun operator bedah thorax kardiovaskular tidak mampu melakukan operasi pembedahan jenis ini. Pasien akhirnya meninggal pada hari kesebelas perawatan. Oleh karena itu diagnosis dan pengobatan yang cepat sangat penting untuk menyelamatkan hidup pasien. Sehingga rumah sakit harus secara preemptif membentuk protokol diagnostik dan terapeutik untuk pasien dengan PE.

Kata kunci: Emboli paru, kor pulmonal, tromboemboli paru, trombolisis

Respiratory Failure As An Early Symptom Of Pulmonary Embolism: ACase Report

The incidence of pulmonary embolism (PE) is very high but the diagnosis is very difficult because the symptoms that arise in each patient vary greatly. There are three clinical features of PE, namely pulmonary infarction, unexplained acute dyspnea, and acute cor pulmonale. In this case the patient has unexplained acute dyspnea. Examination of chest radiographs, electrocardiography and echocardiography showed no abnormalities. Suspicion of PE occurs when the patient has refractory shock for three days of treatment. CT–angiography was performed and the patient was shown to have thrombosis in the left pulmonary artery. Furthermore, the patient underwent percutaneous intraarterial thrombolytic (PIAT) with rtPA. This thrombolysis therapy fails to destroy the thrombus, due to the large and fixed thrombus mass. Furthermore, patients are planned to undergo surgery for embolectomy, but the surgeon of the cardiovascular thoracic is unable to do this surgery. The patient finally died on the eleventh day of treatment. Therefore, diagnosis and rapid treatment are very important to save the lives of patients. So the hospital must be preemptive in establishing diagnostic and therapeutic protocols for patients with PE.

Key words: Cor pulmonale, pulmonary embolism, pulmonary thromboembolism, thrombolysis


Keywords


Emboli paru, kor pulmonal, tromboemboli paru, trombolisis

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