骨科围手术期致死性肺栓塞的特点

Characteristics of fatal pulmonary embolism due to peri-operative orthopedic surgery

[目的]探索骨科围手术期致死性肺栓塞特点,为骨科肺栓塞诊治提供临床依据。[方法]2000～2006年诊治致死性肺栓塞患者15例,回顾诊治过程,分析骨科肺栓塞高危因素、致病原因、发生时间、发病规律、诊治流程、治疗结果等,总结骨科围手术期致死性肺栓塞的特点。[结果]骨科围手术期肺栓塞特点:(1)髋周、脊柱脊髓等部位的骨折手术易诱发近端深静脉血栓形成;(2)骨科围手术期肺栓塞预见性差,误诊率高;(3)骨科围手术期肺栓塞发病急、症状重,易猝死;(4)床边ECG、D-二聚体及心脏超声是致死性肺栓塞简单实用的诊断依据;(5)及时溶栓抗凝治疗对于预后至关重要。[结论]骨科围手术期致死性肺栓塞发病隐匿,病情危重,及时气管插管,简化诊断步骤,缩短治疗时间,是降低骨科围手术期肺栓塞致残、致死率的有效策略。

[ Objective] To investigate the characteristics of fatal pulmonary embolism （PE） due to peri -operative orthopedic surgery and provide clinical recommendations for surgeons. [ Method] Form September 2000 to September 2006,15 cases of fatal PE were treated. All cases were retrospectively analyzed, assessed and compared regard to specific risk factors, diagnostic process, treatment results and preventive measures. [ Result] Orthopedic surgery may lead to proximal deep vein thrombosis （DVT）, especially in patients with spinal cord injury,lower extremity or pelvic fracture. Fatal PE is surprisingly common and is not necessarily heralded by dramatic symptoms or signs associated with DVT, but can lead to substantial morbidity and mortality. So the preventive,diagnostic and therapeutic strategy of PE of orthopedic surgery is different form chronic PE. [ Conclusion]The morbidity of fatal PE duo to peri-operative orthopedic surgery is insidious but serious. Thrombolytic treatment can improve the survival rate for patients with acute pulmonary embolism.