人工关节置换术后肺栓塞的早期诊断和处理

目的：通过对人工关节置换术后发生肺栓塞病例的分析,来探讨人工关节置换术后肺栓塞的早期诊断和处理。方法：共有926例行1336个人工膝关节置换术,1566例行1745个人工髋关节置换术;有5例患者术后诊断肺栓塞,其中2例死亡,均为人工膝关节置换术后,3例抢救成功,2例为人工膝关节置换术后,1例为人工髋关节置换术后。结果：肺栓塞总的发生率为0.2％（5/2492）,人工膝关节置换术中的肺栓塞发生率为0.4％（4/926）,人工髋关节置换术中的肺栓塞发生率为0.06％（1/1566）;2000年以前肺栓塞发生率为0％;发生肺栓塞的患者5例中有2例死亡,其中行人工膝关节置换术的4例中有2例死亡,行人工髋关节置换术的患者则无死亡。结论：肺栓塞尤其大块肺栓塞是人工关节置换术后的主要致死原因;人工膝关节置换术后肺栓塞的发生率高于人工髋关节置换;肺动脉造影术是诊断肺栓塞的金标准,随着医生诊断和集训水平的升高,以及人工关节手术的普及,肺栓塞的诊断率开始出现升高的趋势;高危患者人工关节置换术后应高度重视肺栓塞的发生,检查应抓住鉴别重点;骨科医师如怀疑出现肺栓塞,应及时请内科医师协助,行肺动脉造影术明确诊断,并尽早确定治疗方案。

Early diagnosis and treatment of pulmonary embolism after total joint replacement: report of five cases

Objective To study the early diagnosis and treatment of pulmonary embolism (PE) after total joint replacement (TJR). Methods From April 1987 to December 2001, we performed 1 336 total knee replacements (TKR s) in 926 patients and 1 745 total hip replacements (THR s) in 1 566 patients. In this group there were 5 PE patients after operation. Two patients died (all after TKR), and 3 patients salvaged successfully (2 after TKR, 1 after THR). Results The total incidence of PE after TJR was 0.2%(5/2 492), the incidence of PE after TKR was 0.4%(4/926), and the incidence of PE after THR was 0.06% (1/1 556). In the patients who suffered PE, 2 died. The incidence of PE before 2000 was 0%. Conclusions Death after total joint replacement is due to pulmonary embolism (PE), especially massive PE. The incidence of PE after TKR is higher than that after THR. Pulmonary angiography is the gold standard for the diagnosis of PE. With more understanding on PE and more popularity of joint replacement, the diagnosis of PE after TJR is increadsed. More attention should be paid to PE in the patients with high risk after TJR.