大隐静脉曲张术后并发肺栓塞11例的治疗

Pulmonary embolism after greater saphenous vein ligation and stripping

目的 探讨大隐静脉曲张高位结扎剥脱术后患者并发肺栓塞（pulmonary embolism,PE）的临床特点及预防措施.方法 回顾分析安徽省立医院血管外科2008年1月至2013年6月收治及会诊的大隐静脉曲张术后合并PE的11例患者临床特点、诊疗及预后等资料.结果 该组11例PE患者有6例患者经过心肺复苏、抗凝溶栓等治疗无效死亡,死亡率54.5％.5例患者经过早期的抗凝、溶栓等治疗后康复,在溶栓过程中,2例患者因彩超发现股静脉内漂浮血栓选择下腔静脉滤器植入术.对5例患者经过8 ～ 25个月随访,均无呼吸困难、胸闷、胸痛等症状.患者发病时临床表现以呼吸困难最为常见（90.9％）,有胸痛症状3例（27.3％）,出现晕厥2例（18.2％）,猝死2例（18.2％）,均无典型的呼吸困难、胸痛、咯血三联征.结论 PE的早期诊断及早期治疗可能降低大隐静脉曲张高位结扎剥脱术后PE患者的死亡率.

Objective To analyze characteristics and prophylaxis of pulmonary embolism （PE） after greater saphenous vein ligation and stripping.Methods We retrospectively analyzed the clinical characteristics and treatment of 11 inpatients with postoperative PE in Anhui Provincial Hospital and other hospitals from January 2008 to June 2013.Results In this group 6 patients died after failed cardiopulmonary resuscitation （CPR） and other treatments,the mortality was 54.5%.5 patients recovered after anticoagulation,thrombolysis and other treatments.During the process of thrombolysis,floating thrombus was found within the femoral vein in 2 patients and inferior vena cava filter was implanted.After 8-25 months follow-up,all 5 patients were free of difficulty of breathing,chest tightness,chest pain and other symptoms.Among many clinical manifestations,dyspnea （90.9%） was the most common,other clinical manifestations included chest pain （27.3%）,syncope （18.2%）,sudden death （18.2%）.There was no typical triad of dyspnea,chest pain and hemoptysis in these patients.Conclusions Early diagnosis and early treatment of PE are most important to decrease mortality and to improve the prognosis of patients suffering from postoperative PE.