肺栓塞6例临床报告

目的总结肺栓塞的形成、临床特点及治疗方法.方法搜集卢旺达基本古医院1997年7月至1999年7月肺动脉栓塞6例患者临床资料,对其诊断及治疗作分析总结.结果肺动脉栓塞多见于手术后患者、老年人、久病卧床伴有高黏滞血症者,易形成深静脉血栓.临床表现为咳嗽、胸闷、胸痛、气短和呼吸困难,可通过血液流变学的检查协助诊断,多普勒彩超及血管造影、胸片确诊.结论肺栓塞易被忽视,早期诊断和治疗对改善预后很有价值.     

肺栓塞6例临床报告

目的 总结肺栓塞的形成、临床特点及治疗方法。方法 搜集卢旺达基本古医院1997年7月至1999年7月肺动脉栓塞6例患者临床资料，对其诊断及治疗作分析总结。结果 肺动脉栓塞多见于手术后患者、老年人、久病卧床伴有高黏滞血症者，易形成深静脉血栓。临床表现为咳嗽、胸闷、胸痛、气短和呼吸困难，可通过血液流变学的检查协助诊断，多普勒彩超及血管造影、胸片确诊。结论 肺栓塞易被忽视，早期诊断和治疗对改善预后很有价值。     

骨伤科病人急性肺动脉栓塞

目的　探讨骨伤科患者继发急性肺动脉栓塞的发病率、临床特征和高危因素 ,以及早期诊断和预防肺栓塞。方法　统计1998年 3月～ 2 0 0 2年 7月骨科患者合并致死性肺栓塞 15例 ,进行临床资料回顾性研究分析。结果　肺栓塞死亡数占死亡患者总数的 2 0 8%仅次于颅脑外伤 (4 7 2 % ) ,其中大于 5 0岁、合并髋部或下肢外伤病例有明显统计学意义 (P <0 0 1)。结论　大于 5 0岁、合并髋部或下肢外伤、长期制动、合并心血管疾患患者 ,肺动脉栓塞发病率明显增高。病人可因用力、搬动等诱因突然发病。故本病起病急骤、凶险 ,且治疗手段有限 ,故病死率极高。尸检资料表明 ,肺栓塞发病率远较实际临床诊断为高 ,漏诊率达 80 %以上 ,应引起骨科医生的高度重视     

骨伤科病人急性肺动脉栓塞

目的 探讨骨伤科患者继发急性肺动脉栓塞的发病率、临床特征和高危因素，以及早期诊断和预防肺栓塞。方法 统计1998年3月-2002年7月骨科患者合并致死性肺栓塞15例，进行临床资料回顾性研究分析。结果 肺栓塞死亡数占死亡患者总数的20．8％仅次于颅脑外伤(47．2％)，其中大于50岁、合并髋部或下肢外伤病例有明显统计学意义(P＜0．01)。结论 大于50岁、合并髋部或下肢外伤、长期制动、合并心血管疾患患者，肺动脉栓塞发病率明显增高。病人可因用力、搬动等诱因突然发病。故本病起病急骤、凶险，且治疗手段有限，故病死率极高。尸检资料表明，肺栓塞发病率远较实际临床诊断为高，漏诊率达80％以上，应引起骨科医生的高度重视。     

原发性肝癌经导管肝动脉化疗栓塞术后肺栓塞4例临床分析

目的分析原发性肝癌经导管肝动脉化疗栓塞（TACE）术后并发肺栓塞的临床特点，探讨发生机制、早期诊断和治疗方法。方法2000年1月至2007年12月，在我院接受TACE的原发性肝癌患者31869人次，其中术后出现肺栓塞患者4例。回顾性分析该4例患者的临床特点及发病机制、诊断、治疗方式。结果TACE术后并发肺栓塞例数占同期我院TACE例数的0．02％；出现肺栓塞时间为术后0．5h～5d，患者表现为呼吸困难、紫绀、心悸、胸痛、黄疸、血尿及血PO2、SatO2下降等肺栓塞症状；本组死亡2例，死亡率50％。结论肺栓塞是原发性肝癌患者TACE术后的严重并发症，是碘油阻塞为主的多种栓塞因素共同作用的结果。本病起病急骤，死亡率高。肺动脉造影及D—Dimer是早期明确诊断的重要方法。     

右心房粘液瘤致肺栓塞误诊肺炎二例诊治体会

粘液瘤为心脏良性肿瘤,约20％的粘液瘤位于右心房,质地松脆,瘤屑易脱落,导致肺动脉栓塞,临床易将粘液瘤肺栓塞误诊为肺部感染,进行抗炎治疗而延误手术时机。我们2010年2～8月对2例右心房粘液瘤致肺栓塞误诊为肺炎,现总结其治疗体会,以减少误诊。     

脊柱手术后并发肺栓塞11例临床分析

目的分析脊柱手术后并发肺栓塞的临床特点,探讨早期诊断、治疗方法。方法1995年1月至2006年5月,在我院接受脊柱手术患者10993例,其中术后出现肺栓塞患者11例。回顾性分析该11例患者的临床特点及诊断、治疗方式。结果脊柱术后肺栓塞占同期我院脊柱手术总数的0．1％;出现肺栓塞的时间为术后5～14d（平均9．8d）,患者可见呼吸困难、心悸、胸痛、咯血等特征性肺栓塞症状;本组死亡5例,死亡率45．5％。早期使用肺动脉造影明确诊断、早期经肺动脉导管介入治疗可以显著降低死亡率。结论肺栓塞是脊柱手术后的严重并发症,术后1～2周是致死性肺栓塞的高危时段,死亡率高;肺动脉造影与介入治疗在早期诊断、治疗中占有重要地位。     

骨科手术并发急性肺栓塞的抢救配合及护理

急性肺动脉栓塞症（急性肺栓塞）是内源性或外源性栓子堵塞肺动脉或其分支引起肺循环障碍的l临床和病理生理综合征。据文献报道骨科大手术后易发生深静脉血栓形成，而深静脉血栓又易导致急性肺栓塞，少数可造成致死性肺栓塞导致死亡。骨科手术中又以人工关节置换、髋膝部矫形术后的肺栓塞发生率为最高。2004年5月至2006年6月，笔者所在医院遇到3例骨科术后发生急性肺栓塞的患者。其中1例死亡，2例治愈出院。现将抢救配合及护理体会报告如下。     

肺动脉溶栓配合双J管碎栓治疗亚急性肺栓塞的临床分析

目的探讨亚急性肺动脉栓塞患者应用肺动脉溶栓配合双J管碎栓术的疗效。方法收集2014年5月至2018年8月川北医学院附属医院和广元市第一人民医院收治的亚急性肺栓塞患者84例,分为实验组(40例)和对照组(44例)。对照组仅予以常规抗凝、溶栓,实验组在此基础上予以介入治疗,对比两组患者相关指标及恢复情况。结果实验组治疗后血浆纤维蛋白原浓度、纤维蛋白/纤维蛋白原降解物、血浆D-二聚体、氧分压值明显高于对照组(P<0.05),肺栓塞范围、肺动脉平均压、剩余碱值明显低于对照组(P<0.05),二氧化碳分压两组差异无统计学意义(P>0.05)。多因素Logistic回归分析提示,肺栓塞范围与肺动脉平均压是患者自觉呼吸困难症状改善的独立影响因素。结论肺动脉溶栓配合双J管碎栓在治疗亚急性肺栓塞能有效改善肺动脉通畅率和肺动脉高压症状,值得临床推广。     

人工关节置换术后肺栓塞致死2例临床分析

肺动脉栓塞(PE) 是由内源性或外源性栓子阻塞肺动脉及其分支引起, 下肢深静脉血栓(DVT)是肺栓塞的高危因素.我们在临床中遇到了2例人工关节置换术后发生肺栓塞的患者,现总结如下.     

Acute pulmonary embolism following lung resection: report of two cases

We reported 2 cases of acute pulmonary embolism after resection for lung cancer. A 47-year-old male was admitted to our hospital with ground-glass opacity (GGO) on a chest computed tomography (CT). We performed a right upper lobectomy and node dissection (ND) 2a dissection. Two days after the operation, he developed hypotension and hypoxemia. He was diagnosed as acute pulmonary embolism by chest CT and lung scintigram. A 68-year-old women was performed right S6 segmentectomy for lung cancer. The next day, she complained of sudden chest discomfort and dyspnea. She was diagnosed as acute pulmonary embolism by chest CT. Immediately, we started anticoagration therapy with heparin and their condition were improved. It was very important to early diagnose and start anticoagration therapy immediately for acute pulumonary embolism.     

Experience of four cases of postoperative pulmonary embolism requiring surgical treatment

Four patients underwent a pulmonary embolectomy using cardiopulmonary bypass for acute pulmonary embolism which had occurred after various operations. In two cases, dehydration due to either diabetes insipidus or ileus had existed. In two cases, pulmonary embolism suddenly occurred in our hospital. In the remainder, the disease occurred in the previous hospitals and its diagnosis was established on the 6th and 7th postoperative days, respectively. In massive pulmonary embolism, echocardiography and/or enhanced chest CT are useful for prompt and noninvasive diagnosis. Thrombolytic therapy was performed in only one case before surgical embolectomy, which was not effective. Three patients were discharged without any postoperative complications, but one requiring preoperative external cardiac massage died of multiple organ failure 9 days after operation. Acute pulmonary embolism is one of the fatal postoperative complications. Recognition of this entity, and prompt diagnosis and treatment are essential for managing the fatal disease. Even in the early postoperative period, embolectomy using cardiopulmonary bypass is a safe and effective treatment.     

Pulmonary emboli: the differential diagnosis dilemma

Pulmonary embolism is a rare but serious medical condition, with an estimated mortality of 5% to 20%. Many patients receiving physical therapy may be at risk for developing pulmonary embolism, especially after periods of immobilization or surgery. Patients presenting with dyspnea, chest pain, or tachypnea, particularly after trauma or surgery, have an increased likelihood of pulmonary embolism. Clinical prediction rules have been developed, which can aid the practitioners in assessing the risk a patient has for developing pulmonary embolism. The present clinical commentary discusses the existing evidence for screening patients for pulmonary embolism. To illustrate the importance of the screening examination, a patient is presented who was referred to physical therapy 5 days after cervical discectomy and fusion. This patient was subsequently referred for medical evaluation and a confirmatory diagnosis of pulmonary embolism.     

An unexpectedly high rate of pulmonary embolism in patients with superficial thrombophlebitis of the thigh

PURPOSE: The rate of objectively proven pulmonary embolism in patients with thrombophlebitis of the greater saphenous vein was studied. METHODS: Consecutive ambulant patients with thrombophlebitis of the greater saphenous vein, involving the above-knee segment, underwent a complete venous echo color Doppler examination of the lower limbs, perfusion lung scanning, and chest radiography. A high probability of pulmonary embolism was defined as the presence of two or more large segmental defects, one large and two or more moderate perfusion defects, or four or more moderate perfusion defects, with no corresponding abnormality found by means of chest radiography. RESULTS: Of the 21 patients included in the study, findings compatible with a high probability of pulmonary embolism were detected in seven patients (33.3%; 95% CI, 14.6 to 57. 0), although clinical symptoms of pulmonary embolism were present only in one patient. No association was found between the presence of thrombosis at the saphenofemoral junction and the risk for pulmonary embolism. CONCLUSION: The rate of pulmonary embolism in patients with thrombophlebitis of the greater saphenous vein is unexpectedly high. This risk is similarly high in patients with thrombosis at the saphenofemoral junction and in patients without thrombosis at the saphenofemoral junction. Our results are consistent with those of other recent investigations and suggest that superficial thrombophlebitis of the thigh is not as benign a disease entity as previously described.     

Pulmonary embolism in three surgical patients despite prophylactic measures

Pulmonary embolism after surgery became a major problem in Japan recently. From the year 2000, we started the prophylaxis against pulmonary embolism in orthopedic or gynecological surgical patients with some risk factors of pulmonary embolism. But we experienced three cases of pulmonary embolism although two of them had received subcutaneous heparin after surgery. We consider that prophylactic measures are recommended for the patient with risk factors of pulmonary embolism. Pulmonary embolism should be considered when surgical patients complain of abnormality such as chest pain.     

Fatal Pulmonary Embolism After Total Hip Replacement

A retrospective study of fatal pulmonary embolism (FPE) was carried out in 1,324 cases of total hip replacement (THR), performed during 1969 to 1978. Dextran 70 (Macrodex® 6 per cent in saline, Pharmacia AB, Sweden) was given as thromboembolic prophylaxis. Sixteen patients died within 3 months. Autopsy was performed in 14 cases. Nine died from embolism, which makes an incidence of 0.7 per cent. Autopsy was performed in 8 of these cases. Seven patients died during the second and third week. Five patients had complained of acute chest pain and 4 of them had chest radiograms taken, which were normal. Only one patient had clinical symptoms of deep vein thromboses. Perfusion lung scan was performed as a screening procedure in 3 cases, all of them showing defects typical of pulmonary embolism. Four patients died from FPE, despite heparin therapy for 3–5 days. A comparison between patients with FPE and a control group showed that premonitory attacks of acute chest pain and previous operations for orthopaedic reasons were significantly more common in patients with FPE (P < 0.001 and P < 0.05), respectively). No difference could be found between the groups concerning blood loss, amount of transfusion, sex, operated side, type of prosthesis and weight.     

Should pulmonary embolism be suspected in exacerbation of chronic obstructive pulmonary disease?

BACKGROUND: The cause of acute exacerbation of chronic obstructive pulmonary disease (COPD) is often difficult to determine. Pulmonary embolism may be a trigger of acute dyspnoea in patients with COPD. AIM: To determine the prevalence of pulmonary embolism in patients with acute exacerbation of COPD. METHODS: 123 consecutive patients admitted to the emergency departments of two academic teaching hospitals for acute exacerbation of moderate to very severe COPD were included. Pulmonary embolism was investigated in all patients (whether or not clinically suspected) following a standardised algorithm based on d-dimer testing, lower-limb venous ultrasonography and multidetector helical computed tomography scan. RESULTS: Pulmonary embolism was ruled out by a d-dimer value <500 microg/l in 28 (23%) patients and a by negative chest computed tomography scan in 91 (74%). Computed tomography scan showed pulmonary embolism in four patients (3.3%, 95% confidence interval (CI), 1.2% to 8%), including three lobar and one sub-segmental embolisms. The prevalence of pulmonary embolism was 6.2% (n = 3; 95% CI, 2.3% to 16.9%) in the 48 patients who had a clinical suspicion of pulmonary embolism and 1.3% (n = 1; 95% CI, 0.3% to 7.1%) in those not suspected. In two cases with positive computed tomography scan, the venous ultrasonography also showed a proximal deep-vein thrombosis. No other patient was diagnosed with venous thrombosis. CONCLUSIONS: The prevalence of unsuspected pulmonary embolism is very low in patients admitted in the emergency department for an acute exacerbation of their COPD. These results argue against a systematic examination for pulmonary embolism in this population.     

Chest injuries: a clinical and autopsy profile

The clinical profiles and management of 236 consecutive chest injury patients treated and followed up at All India Institute of Medical Sciences between January 1983 and July 1985 were analyzed prospectively. There were 149 blunt and 87 penetrating injuries; 21 patients (9%) required thoracotomy. Single- or multiple-tube thoracostomy was performed in 141 patients (60%). The remaining 74 patients (31%) required only observation for a period of 24-48 hours. Fifteen patients (6.3%) died, the mortality being related to head injury in four, irreversible hypovolemic shock in four, pulmonary embolism in three, septicemia in two, and respiratory failure in two. Nonfatal complications included residual hemothorax in 18 cases, persistent air leak in 13, pulmonary infection in eight, pulmonary embolism in one, and empyema in one. The average hospital stay was 6.9 days. Evidence of chest injury of various magnitudes was found in 756 of 2,286 autopsies conducted for trauma-deaths during the same study period analyzed retrospectively; however, it was the major cause of death in only 147 (19%). Cardiac injuries accounted for 41% of the deaths resulting primarily from chest trauma. Only 10% of the patients who sustained cardiac injury reached hospital alive.     

Chest disease presenting as an acute abdomen.

Four patients with primary disease in the chest are discussed, each coming to laparotomy. The final postoperative diagnoses were empyema, pulmonary tuberculosis, pulmonary embolism and bacterial endocarditis. These cases well illustrate the real risk of confusing an acute chest condition with an acute abdomen.     

Three cases of pulmonary embolism incorrectly diagnosed as lung cancer

Pulmonary embolism is commonly misdiagnosed as lung cancer, since sputum cytological tests often show atypical or malignant cells. We report three operated cases of pulmonary embolism incorrectly diagnosed as lung cancer. The first patient is a 39-year-old male with chest pain an bloody sputum. Chest x-ray revealed abnormal shadows and subsequent sputum cytological tests identified malignant cells. The second patient is a 63-year-old male with the same diagnostic pattern as the first case. The third patient is a 72-year-old male whose routine chest x-ray showed an abnormal shadow; malignant cells were identified by cytological tests on transbronchial fiberscope brushings. These three patients were histopathologically diagnosed as suffering pulmonary embolism by wedge resection under thoracotomy. When a patient has chest pain or bloody sputum with showing temporarily malignant cells on cytology, the possibility of pulmonary embolism should be taken into consideration.