外科手术后急性肺栓塞临床分析

Clinical characteristics of acute pulmonary embolism following surgery

目的 分析外科手术后患者急性肺栓寨的临床特点,以提高临床医师对术后急性肺栓塞的认识并增强早期预防观念.方法 对北京大学第三医院2000年1月至2008年1月8年问31例外科手术后急性肺栓塞患者的一般资料、临床表现、诊断、治疗和预后进行回顾分析.结果 ①术后急性肺栓塞占所有急性肺栓塞的比率为21.9%,其病死率为3.2%.②术后急性肺栓塞常见于脊柱手术、恶性肿瘤手术、腹腔手术、妇科手术和关节置换手术等.术后急性肺栓塞常发生于术后一周之内,恶性肿瘤术后发生肺栓塞的时间更早.③临床表现以呼吸困难最常见（90.3%）,其次为胸痛、心悸、晕厥较常见,典型的呼吸困难、胸痛、咯血三联症并不多见.④静脉溶栓治疗禁忌用于术后大面积肺栓塞,介入取栓、碎栓或外科取栓是重要的替代治疗措施.结论 外科手术是急性肺栓寒的一个重要危险因素;术后患者出现呼吸困难、胸痛、晕厥等表现时,临床医师应警惕肺栓塞;积极抗凝或取栓治疗可以改善患者预后.

Objective To analyze the clinical characteristics, diagnosis, therapy and prognosis of acute pulmonary embolism （APE） following surgery so as to advise clinicians to pay more attention to and prevent postoperative APE. Method Thirty-one APE patients following surgery treated in the recent 8 years were analyzed retrospectively. The clinical features, diagnosis, therapy and prognosis of patients were analyzed. Results （1） Post-operative APE patients accounted for 21.9% of all APR patients during that period. The mortality of patients after surgical operation was 3.2%. （2） APE following surgery often occurred in patients after operations of spine, abdomen, gynecological surgery and point replacement as well as in patients with malignant tumor. The APE following surgery often occurred in the first week after surgery. The APE after surgery for malignant tumor occurred sooner. （3） Among many clinical manifestations, dyspnea （90.3%） was the commonest one. Other manifestations included chest pain, palpitation and syncope. The typical triad of dyspnea, hemoptysis and cheat pain was rarely seen. （4） The venous thrombolysis was a absolute contra-indication for massive PE after surgery. Catheter embolectomy and fragmentation, and surgical embolectomy were the alternative treatment. Conclusions Surgery is the essential risk factor of APE. When patients present dyspnea, chest pain or syncope, clinicians should pay attention to APE. Anticoagulation and embolectomy can improve the prognosais of the patients.