手术相关肺栓塞45例临床分析

目的 回顾分析手术后患者肺栓塞的发病情况,以引起外科医师对该病预防和诊治的重视.方法 回顾性分析2004年6月至2009年2月共45例手术后肺栓塞患者的临床资料.从患者的手术种类、手术时间、麻醉方式、发生肺栓塞的危险因素、临床表现、辅助检查、诊断、治疗及转归等方面进行综合分析.结果 45 例患者中,平均年龄(60±16)岁,其中抗凝治疗35例,溶栓治疗6例,仅予急救治疗4例,37例(82.2%)肺栓塞发生于术后2周内,占同期住院肺栓塞患者的13.2%(45/341).肺栓塞最常见于普通外科(35.6%)、妇产科(13.3%)、骨科(13.3%)、胸外科(11.1%)等手术,尤其是与恶性肿瘤相关手术术后(57.8%).平均手术时间(220±124)min,全身麻醉37例(82.2%).临床表现及辅助检查缺乏特异性;经抗凝等治疗好转36例,死亡9例,病死率20.0%(9/45).结论 手术是发生肺栓塞的重要危险因素,应该重视手术相关肺栓塞的预防和诊治.

Clinical analysis of 45 cases with pulmonary thromboembolism after surgical procedures

Objective To analyze the occurrence of pulmonary thromboembolism (PIE) after surgical procedures to attract more attention to the prevention,diagnosis and treatment of this disease.Methods Retrospectively analyze the clinieal data of the hospitalized patients with post-surgical PTE from June 2004 to February 2009.The average age of the 45 cases was(60±16)years old,35 cases received anticoagulant therapy and 6 cases received thrombolytic therapy.the other 4 cases only received emergency medical treatment.Analyze the data about the surgery category,duration,anaesthetic way,risk factors,clinical symptoms,auxiliary examinations,diagnosis,treatment and turnover of these patients.Results Among the total 45 cases of post-surgical PTE,37 cases(82.2%)occurred within 2 weeks,it accounted for 13.2%(45/341)of the hospitalized PTE patients during that period.PTE was often seen in patients after major surgical operation such as general (35.6%),gynecological(13.3%),orthopedic (13.3%) and chest surgery,especially the surgery related to malignant tumor(57.8%).The average surgical duration wag (220±124) min,37 cases(82.2%)was given general anaesthesia.The clinical manifestations and auxiliary examinations results of post-surgical PTE were not typical.Thirty-six cases improved after treatment.9 cases died and the cage fatality ratio Was 20.0%(9/45).Conclusions Surgical procedure is an important risk factor of PTE.The prevention diagnosis and treatment of post-surgical PTE should be paid more attention to.