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1.
目的探讨急性肺动脉栓塞的介入治疗效果。方法 2009年10月~2011年5月对19例急性肺动脉栓塞行下腔静脉滤器植入,肺动脉造影,导管碎栓、抽栓、溶栓治疗,其中12例术中应用球囊辅助碎栓,术后处理联合应用低分子肝素和华法林,调整凝血酶原国际标准化率在2~3。结果术中即刻造影显示8例主干完全开通,11例部分开通。术中16例肺动脉压下降至16~37 mm Hg,3例肺动脉压升高至39~62 mm Hg,考虑末梢血管痉挛所致。基本治愈8例,显效5例,有效3例,无效3例。19例随访2~26个月,平均18个月,未见复发。结论急性肺动脉栓塞的介入治疗可以迅速恢复肺灌流量且相对于外科手术微创、简单,与全身静脉溶栓比较更迅速、有效。 相似文献
2.
Hiroshi Yamasaki Hideki Ujiie Tatsuya Kato Yasuhiro Hida Kichizo Kaga Satoru Wakasa Yoshihiro Matsuno 《Annals of thoracic and cardiovascular surgery》2021,27(6):371
Purpose: Pulmonary nodules suspected to be cancerous are rarely diagnosed as pulmonary infarction (PI). This study examined the clinical, radiological, and laboratory data in cases diagnosed with PI to determine their potential utility as preoperative diagnostic markers. We also assessed factors affecting the postoperative course.Methods: A total of 603 cases of peripheral pulmonary nodules undiagnosed preoperatively were resected at Hokkaido University Hospital from 2012 to 2019. Of these, we reviewed cases with a postoperative diagnosis of PI. We investigated clinical symptoms, preoperative laboratory data, radiological characteristics, and postoperative complications.Results: Four patients (0.7%) were diagnosed with PI. All patients had a smoking history. One patient received systemic steroid administration, and none had predisposing factors for thrombosis. One case showed chronologically increased nodule size. Three cases showed weak uptake of 18F-fluorodeoxyglucose. One patient with preoperative high D-dimer levels developed a massive pulmonary embolism (PE) in the postoperative chronic phase and was treated with anticoagulants.Conclusions: Preoperative diagnosis of PI is difficult, and we could not exclude lung cancer. However, if a patient diagnosed with PI has a high D-dimer level, we recommend postoperative physical examination for deep venous thrombosis. Prophylactic anticoagulation therapy should be considered to avoid fatal PE. 相似文献
3.
Review of Acute Pulmonary Embolism in a General Hospital 总被引:2,自引:0,他引:2
Purpose Acute pulmonary embolism (APE) is a serious cardiovascular disease associated with high mortality rates. We analyzed the clinical
characteristics, treatment, and outcome of patients with APE in a general hospital in Japan.
Methods The subjects were 14 patients with APE: 6 with out-of-hospital onset and 8 with in-hospital onset.
Results The incidence of APE in hospitalized patients was 0.03% (95% confidence interval, 0.01%–0.05%). Eight patients suffered shock
and three patients suffered cardiac arrest. Advanced age, deep vein thrombus (DVT), cancer, fracture, obesity, and surgery
were common risk factors. In the hospitalized patients, surgery was a major risk factor: APE developed perioperatively in
five (63%) of eight patients. Nine patients were treated with heparin alone, three were treated with thrombolysis, and two
underwent surgical embolectomy for right heart thrombi. Three of the patients who suffered shock died during hospitalization
and another died of recurrence 2 months after the first episode. Overall in-hospital and 3-month mortality rates were 21%
and 29%, respectively, and the in-hospital mortality rate of the patients with shock was 38%.
Conclusion Acute pulmonary embolism was associated with high mortality rates and surgery was the most common risk factor predisposing
to APE in hospitalized patients. Thus, standardized prophylaxis against DVT is essential for patients undergoing surgery. 相似文献
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5.
急性肺动脉栓塞外科治疗 (附5例报告) 总被引:14,自引:0,他引:14
5例急性肺动脉栓塞并发肺源性心脏病及呼吸功能衰竭病人行肺动脉切开取栓术。2例病人术后长期存活,心功能由IV级改善为I级,并口服华法林治疗未发生再栓塞;2例病人术中死于右肺出血;1例病人手术成功,顺利脱离呼吸机,术后亦行口服华法林抗凝治疗,但于术后第4天死于肺动脉再栓塞。结论:适时而恰当的手术决策是提高手术疗效的关键,术后除抗凝治疗外,还需要在下腔静脉内置入滤网才能更有效地预防再栓塞 相似文献
6.
Mark P. Cote Anthony Chen Yue Jiang Vincent Cheng Jay R. Lieberman 《The Journal of arthroplasty》2017,32(12):3833-3839
Background
Symptomatic pulmonary embolism (PE), a significant and life-threatening complication following total knee arthroplasty (TKA), has been described as a “never event.” Despite a number of advancements in care, PE continues to occur following TKA. This study evaluates symptomatic PE rates over time in TKA patients enrolled in multicenter randomized clinical trials assessing the efficacy of venous thromboembolism prophylaxis regimens.Methods
The MEDLINE and Cochrane Central Register of Controlled Trials were searched to identify clinical trials assessing prophylactic anticoagulation in patients undergoing TKA between January 1995 and December 2016. A random effect model was used to combine PE rates across studies. The pooled proportion of symptomatic PEs was calculated and heterogeneity was quantified with the I2 statistic. A 95% prediction interval was constructed to examine what the expected range in the proportion of symptomatic PEs would be in future studies. Meta-regression was used to explore the effect of time on the rate of symptomatic PEs.Results
A total of 18 studies representing 27,073 patients were included in the meta-analysis. The symptomatic PE rate was 0.37% (95% confidence interval, 0.24%-0.52%). There was significant heterogeneity across studies, I2 = 66%. Between 1996 and 2010, the proportion of PEs did not change in the regression analysis. The 95% prediction interval was 0.0002 to 0.0106, indicating that in similar future studies, the true proportion of symptomatic PEs would range from 0.02% to 1.06%.Conclusion
Over a 14-year period, the symptomatic PE rate after TKA was relatively constant even when patients received potent anticoagulation. These results suggest that some patients may have a genetic predisposition to develop a PE and more effective risk stratification protocols need to be developed to make sure patients receive appropriate anticoagulation. 相似文献7.
Background
A symptomatic pulmonary embolism (PE) after total joint arthroplasty has been described as a “never event.” Despite potent anticoagulants and improvements in patient care, PE continues to occur following total hip arthroplasty (THA). This study evaluates symptomatic PE rates over time in THA patients enrolled in multicenter randomized clinical trials (RCTs) assessing the efficacy of venous thromboembolism prophylaxis regimens.Methods
The MEDLINE and Cochrane Central Register of Controlled Trials were searched to identify clinical trials assessing prophylactic anticoagulation in patients undergoing THA between January 1995 and December 2015. Inclusion criteria consisted of RCTs evaluating prophylactic anticoagulation in patients undergoing THA. A random effect model was used to combine PE rates across studies.Results
A total of 21 studies (34,764 patients) were included. Patients were administered low molecular weight heparin (13,590 patients), oral factor Xa inhibitors (6609 patients), oral direct thrombin inhibitors (5965 patients), indirect factors Xa/IIa inhibitors (3444 patients), aspirin (2427 patients), and warfarin (489 patients). Mobile compression was used in 199 patients, and placebo was used in 2041 patients. Across all included studies, the estimated PE rate was 0.21% (95% confidence interval: 0.13%, 0.32%). Between 1997 and 2013, the proportion of PEs did not change in regression analysis.Conclusion
Although the PE rate was low, it was consistent throughout the 17 years spanning these RCTs, which excluded patients with significant morbidity. These results suggest that even healthy THA patients receiving aggressive anticoagulation still have a risk for PE, and the “never event” designation requires reassessment. 相似文献8.
9.
《Acta orthopaedica》2013,84(3):407-411
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. 相似文献
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《Scandinavian cardiovascular journal : SCJ》2013,47(3-4):121-126
We performed less than lobar resections for peripheral clinical Stage I primary lung cancers on 170 patients treated between 1973 and 1987 at two university centers, one in Hawaii and one in Israel. Most patients were poor risks and several had FEV1< 1 liter. There were 6 (3.5%) hospital deaths. There were 58 segmental resections, 97 wedge resections and 15 less than lobar resections not otherwise specified. Seventy-three patients (43%) are living free of cancer from 5 to 11 years postoperatively and 20 additional patients died of causes unrelated to lung cancer after 5 years; thus disease free five year survival was 54.7%. Patients with adenocarcinoma had poorer prognosis than other cell types. Twenty-three patients (13.5%) had synchronous or metachronous second primary lung cancers. Nine of these patients are long term survivors. Twenty-four patients (14.1%) developed local recurrences with or without distant metastases. This promising long term cancer-free survival and the frequency of second primary lung cancers justifies less than lobar resection for peripheral. Stage I bronchogenic carcinoma, especially in the poor risk patient. 相似文献
12.
《The Journal of arthroplasty》2020,35(6):1703-1707
BackgroundThe purpose of this study is to investigate the incidence and timing of postoperative, symptomatic pulmonary embolism (PE) in patients receiving nonwarfarin treatment following primary total joint arthroplasty (TJA), to clarify the appropriate duration of postoperative VTE prophylaxis.MethodsWe retrospectively reviewed the medical records of 11,148 patients who underwent primary TJA, including total knee arthroplasty and total hip arthroplasty at our institution between January 2012 and March 2019. The median postoperative day of diagnosis of symptomatic PE and the interquartile range for day of diagnosis were determined. Multivariate Cox proportional hazards modeling was used to test the difference of timing for PE based on demographics and comorbidities.ResultsThe overall 90-day rate of symptomatic PE was 0.71%. The median day of diagnosis for symptomatic PE was 3 days postoperatively (interquartile range, 2-7 days). Factors showed statistical significance on multivariate analysis in association with earlier timing of PE occurrence in patients with atrial fibrillation, diabetes mellitus, coronary heart disease, and history of stroke.ConclusionThe vast majority of symptomatic PE occurs in the early postoperative period after TJA, and atrial fibrillation, diabetes mellitus, coronary heart disease, and history of stroke were independent factors affecting the timing of symptomatic PE. 相似文献
13.
Fat embolism syndrome (FES) after liposuction is likely a life-threatening disorder, though its incidence is low. The three chief clinical manifestations include respiratory insufficiency, cerebral involvement, and petechial rash. Although FES is a multisystem disorder, the most seriously affected organs are the lungs, brain, cardiavascular system, and skin. Many laboratory findings are characteristic but nonspecific. The pathogenesis of FES after liposuction has been looked at both mechanically and biochemically. Diagnosis is difficult; Gurd and Wilson's diagnostic criteria based on clinical examination is still extensively used in clinics at present. There is no specific therapy for FES after liposuction for the moment, so prevention, early diagnosis, and supportive therapies are important. In this article we discuss the clinical presentation, pathogensis, and current methods to prevent FES and, if possible, ways to treat this complication. 相似文献
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15.
目的探讨电视胸腔镜(VATS)肺叶切除术后急性肺动脉栓塞(pulmonary embolism,PE)的诊断、治疗及其预防措施。方法 2007年1月至2010年11月广州医学院第一附属医院对1 115例肺癌患者施行电视胸腔镜肺叶切除术,术后发生急性PE 13例,男6例,女7例;平均年龄62.3(42~73)岁。所有患者均经胸部螺旋CT肺动脉造影(SCTPA)确诊,均接受低分子肝素和华法林抗凝治疗。结果电视胸腔镜肺叶切除术后急性PE发生率为1.17%(13/1 115),低危患者比例高(11/13),发生右侧PE 12例,接受抗凝治疗后症状均缓解,有9例患者复查SCTPA显示栓塞消失或明显吸收,无胸腔出血、伤口渗血等并发症;随访1~3个月均未发现复发。结论电视胸腔镜肺叶切除术后发生急性PE的诊断首选SCTPA检查,需采用适当的预防和治疗措施;术后PE发生率低,低危比例高,体现了微创外科手术的优势。 相似文献
16.
Venous thromboembolic events have several known major risk factors such as prolonged immobilization or major surgery. Pulmonary embolism has rarely been reported after an outpatient vasectomy was completed. We present the rare case of a healthy 32-year-old Caucasian male with no known risk factors who presented with pleuritic chest pain 26 days after his outpatient vasectomy was performed. Subsequently, he was found to have a pulmonary embolism as per radiological imaging. We explore the association between outpatient vasectomies and venous thromboembolic events. A review of the literature is also included.Key Words: Vasectomy, Pulmonary embolism, Thrombophlebitis, Thromboembolism risk factors 相似文献
17.
Alejandro Gonzalez Della Valle Alvaro Blanes Perez Yuo-yu Lee Gregory R. Saboeiro Gabrielle P. Konin Yoshimi Endo Nigel E. Sharrock Eduardo A. Salvati 《The Journal of arthroplasty》2017,32(4):1304-1309
Background
In the event of a postoperative pulmonary embolism (PE), it is generally believed that patients with centrally located emboli will have worse clinical symptoms than those with segmental or subsegmental ones. We studied if a relationship exists between the clinical severity at the time of PE diagnosis and the location of the emboli within the pulmonary vasculature.Methods
All 269 patients who developed an in-hospital, computed tomography pulmonary angiography-proved, PE following elective total hip arthroplasty or total knee arthroplasty in our institution were studied. The clinical severity of the PE was calculated using the Pulmonary Embolism Severity Index (PESI) that classifies patients in 5 classes (class 5: most severe). All computed tomography pulmonary angiographies were re-reviewed to determine the location of the emboli within the pulmonary vasculature (central, segmental, or subsegmental—unilateral or bilateral). The association between PESI and the PE location was examined.Results
The most proximal location of the emboli was central in 62, segmental in 139, and subsegmental in 68. There were 180 unilateral and 89 bilateral PE patients. There was no association between the PESI and the location of the emboli within the pulmonary vasculature (P = .32). Patients with bilateral or unilateral lung involvement had similar PESI (P = .78).Conclusion
The PESI, a recognized, validated predictor of mortality after PE was similar in patients with central, segmental, or subsegmental PE; and in patients with unilateral or bilateral lung involvement. The present study may aid clinicians while assessing and discussing the severity of PE symptoms with patients at the time of diagnosis. 相似文献18.
G. Shpolyanski M. Hashmonai M. Rudin N. Abaya U. Kaplan D. Kopelman 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2012,16(2):337-339
Background:
Air embolism is a relatively rare complication of thoracoscopic surgery.Methods:
Open supraclavicular sympathectomy was indicated to overcome the risk of re-embolization. A novel video-assisted technique was performed.Conclusions:
The previously prevalent open supraclavicular sympathectomy is a good choice for avoiding air embolism. Laparoscopic instrumentation and technology can be used to improve open procedures, especially when exposure and visibility are limited. Sometimes we should remember to use the experience of our teachers. 相似文献19.
Hans O. Fredin 《Acta orthopaedica》1983,54(2):164-167
The effect of anticoagulative treatment of pulmonary embolism was studied in 63 patients out of 348 operated on with total hip replacement. Screening diagnosis of pulmonary embolism was obtained from 99mTc perfusion scintigraphy in combination with 99mTc-microaerosol ventilation scintigraphy and chest radiogram. the administration of heparin and warfarin was associated with hemorrhagic side effects in 7 per cent. the final outcome of surgery, however, was not interfered with. Fatal pulmonary embolism occurred in one patient (0.3 per cent) in whom the diagnosis had been missed. 相似文献
20.
Intermittent Pneumatic Compression Is Effective in Preventing Symptomatic Pulmonary Embolism After Thoracic Surgery 总被引:2,自引:0,他引:2
Purpose. Postoperative pulmonary embolism (PE) remains a fatal complication even in thoracic surgery. We have used intermittent pneumatic compression for the prophylaxis of postoperative PE since 1998, and herein examined its effectiveness.
Methods. Seven hundred and six patients, whose medical records showed use/no use of pneumatic compression for prophylaxis of PE, underwent general thoracic surgery in our department from December 1995 to December 2000. Their clinical records were reviewed, and variables were compared between patients who experienced clinically apparent PE and patients who did not have PE.
Results. Three hundred and forty-four patients did not receive any prophylactic treatment, and 7 of these (2.0%) experienced postoperative PE. Three hundred and sixty-two patients received prophylactic pneumatic compression and none of these developed PE. There was a statistical correlation between the occurrence of PE and the application of pneumatic compression (2-test, P = 0.006). Six of the seven patients with PE were operated on in the right decubitus position, and the operative position and the prevalence of PE was also significantly correlated (2-test, P = 0.024). Other factors, such as age, sex, operative time, duration until patients became fully ambulatory, body mass index, and character of the disease, did not have significant correlation with the occurrence of PE.
Conclusions. Pneumatic compression was found to effectively prevent postoperative PE. The right decubitus position is considered to be a risk factor for the development of postoperative PE in thoracic surgery. 相似文献