脾切除术后大面积肺血栓栓塞猝死1例并文献复习

Sudden death due to pulmonary thromboembolism following splenectomy:a case report and review of the litera tures

目的提高对脾切除术后急性肺血栓栓塞症(APE)的认识。方法结合1例外伤后脾切除术后发生APE患者的临床资料及诊治过程,并复习相关文献,对脾切除术后肺栓塞的临床表现、治疗及尸检结果进行分析。结果患者,男,61岁,因"车祸伤致右肩、胸部、左膝多处疼痛半小时"于2011年12月3日入院。于2011年12月4日凌晨急诊行脾切除术,术后予抗感染,化痰,解痉平喘,拜阿司匹林抗血小板凝集等对症治疗,病情一度好转,于2011年12月26日8:40患者自行下床上厕所后突然出现胸闷气急,大汗淋漓,予气管插管有创通气,胸外心脏按压,多巴胺、肾上腺素、阿托品等血管活性物质后患者始终无自主心律,抢救大约3 h后宣告死亡。尸检报告示:肺动脉血栓栓塞形成,混合血栓栓子;肺出血、肺淤血。结论脾切除术后肺栓塞少见,肺栓塞的病死率高,术后应预防性应用抗血小板聚集及抗凝药物,降低肺栓塞的发生。

Objective To improve the understanding of the clinical manifestations of pulmonary thromboembolism after splenectomy.Methods A case of pulmonary thromboembolism after splenectomy was reported,and the literatures were reviewed.The epidemiologic,clinical and diagnostic aspects of pulmonary thromboembolism after splenectomy was discussed.Results A 61 year old man was admitted to the hospital because of traffic accident hurting his right shoulder,left knee and chest pain for half an hour.After several hours,diagnosis of splenic trauma was established and the emergency splenectomy was performed in one third-class hospital.Postoperative treatment included anti-infection,antiplatelet aggregation,spasmolysis breathes were carried out.And the patient's condition was well.The chest CT showed no difference.But on the 22th day after splenectomy,the patient suddenly felt chest stuffy,dyspnea during early ambulation.And he died after three hours' rescure.The final autopsy report showed: pulmonary thromboembolism formation,mixed thromboembolus;pulmonary hemorrhage.Conclusions Pulmonary thromboembolism after splenectomy is uncommon.Earlier use of anticoagulation drug might decrease the mortality rate.