神经外科术后无症状肺血栓栓塞症的诊断及处理

The diagnosis and treatment of silent pulmonary thromboembolism in post-neurosurgical-operative paitents

目的探讨神经外科术后无症状肺血栓栓塞症,提高术后深静脉血栓及无症状肺血栓栓塞症的诊断及治疗水平。方法分析我院神经外科诊断并治疗的2例无症状肺血栓栓塞症患者的临床资料,通过D-dimer、超声、CTPA进行筛查及诊断,明确诊断后予以肝素及低分子肝素抗凝治疗,后期行华法林抗凝,其中1例在抗凝治疗前急诊行下腔静脉永久滤网植入术。结果本组D-dimer 1例正常,1例稍高于参考值上限;超声证实2例患者均有下肢静脉血栓;CTPA明确诊断为肺血栓栓塞症。抗凝治疗后复查CTPA,肺血栓栓塞症有明显改善。2例患者出院后继续华法林抗凝治疗。结论临床工作中应重视发生肺血栓栓塞症的各种危险因素,及早对高危人群进行筛查,制定围手术期的整体预防和治疗方案。

Objective To study the silent pulmonary thromboembolism（SPE） and so to improve the diagnosis and treatment of neurosurgical patients.Methods To analyze the clinical data of 2 cases who were diagnosed as SPE.Based on screening of D-dimer,ultrasound imaging and CTPA,the patients were diagnosed and treated with low-dose heparin or low-molecular-weight heparin and then with warfarin.One of the 2 cases had implanted permanent inferior vena cava filters before anticoagulation.Results One of the result of D-dimer is 573 μg/L（156 μg/L after treatment）,the other is 246 μg/L（50 μg/L after treatment）.The ultrasound imaging showed the low extremities vein thrombosis and CTPA confirmed the pulmonary thromboembolism.Both of them discharged after re-examinations with CTPA which showed the improvement of pulmonary thromboembolism.Conclusion The neurosurgeons should pay much attention to the high risk of PE and to identify such patients ealier.The critical issue is to make a peri-operative program of prevention and treatment.