胸部肿瘤手术后肺栓塞的防治

Prevention and Treatment of Post-operative Pulmonary Embolism in the Patient with Chest Tumor

目的探讨能有效地降低或避免胸部肿瘤手术后肺栓塞并发症的围手术期补液方案。方法补液新方案包括,改变术中、术后输液径路;术后放弃所有止、凝血药物的使用;术后第3天始常规应用抗凝药物;比较新补液方案实施前后为两组患者,术后下肢深静脉血栓及肺栓塞发生率。结果实施新补液方案前,术后下肢深静脉血栓发生率为0.60%(16/2676),肺栓塞发生率为0.41%(11/2676),死亡率为0.30%(8/2676);实施新补液方案后,术后下肢深静脉血栓发生率及肺栓塞发生率均为0(0/1210)(P<0.001)。结论预防性新补液方案可以降低术后下肢深静脉血栓形成率和肺栓塞的发生率。

Objective To study if the new infusion scheme, beginning from January 2002, could prevent post-operative pulmonary embolism in the patient with chest tumor, Methods The new infusion scheme including the following aspects. First, we change the way of infusing during and after the operation, Second, no anticoagulants were used during the first 3 days after operation. And last, anticoagulants were routinely used 3 days after operation. The rates of pulmonary embolism after surgical treatment were compared. Results The incidence of vein thrombus in lower limbs was 0.60% （ 16/2 676） and the pulmonary embolism was 0.41% （11/2 676）, and mortality was 0, 30% （8/2 676） before the prevention scheme was applied. No vein thrombus in lower limbs and pulmonary embolism was detected （0/1210）, （P 〈 0.001 ） after the new infusion scheme was used. Conclusion The prevention scheme, which was designed to be used during and after operation, can reduce and prevent the serious complication-pulmonary embolism in patients with chest operation.