妇科围手术期肺栓塞21例临床分析

Twenty-one gynecological cases with pulmonary embolism during perioperative period

目的肺栓塞具有发病急、病情重、病死率高、预后差等临床特点。通过分析妇科围手术期患者肺栓塞的发生情况,提高围手术期防治肺栓塞的意识,减少肺栓塞发病率,提高其诊断率。方法回顾性分析2005-01-01—2015-06-30北京大学第三医院妇产科妇科病房21例围手术期肺栓塞患者的临床资料。21例肺栓塞患者中位年龄63岁。发生于手术后15例,其中恶性肿瘤11例(73.3%);发生于术前6例。结果 21例患者中,出现胸闷气短9例,咳嗽6例,呼吸困难3例,胸痛1例,晕厥4例,咯血1例,无症状5例。20例经肺CT肺动脉造影(computed tomographic pulmonary angiography,CTPA)检查的患者中有19例获得明确诊断,1例CTPA未见栓子,行肺灌注扫描,表现为肺多发血流灌注减低,呈外周分布,以亚段性为主;另外1例有癫痫病史直接经肺灌注确诊。21例患者给予溶栓、抗凝和(或)介入等治疗,20例好转,因病情严重放弃治疗1例。结论肺栓塞临床表现差异大,出现典型呼吸困难、胸痛、咳血典型三联症状较为少见。手术是引起肺栓塞的重要危险因素,也可发生于术前,尤其是合并恶性肿瘤的老年患者,应引起警惕。肺栓塞风险评估后积极预防可明显降低围手术期肺栓塞发生率。对于易患因素者,CTPA和肺灌注扫描有助于早期发现肺栓塞。

OBJECTIVE Pulmonary embolism have acute onset,severe illness,high mortality,poor prognosis and other clinical characteristics.In order to reduce its morbidities,improve its diagnostic rate and the awareness of diagnosis and treatment for pulmonary embolism.We analysis the occurrence of pulmonary embolism in patients with gynecological diseases during perioperative period.METHODS The clinical data of gynecological patients who developed pulmonary embolism during perioperative Period were retrospectively analyzed in Peking University Third hospital from 2005to2015.Twenty-one cases of patients with pulmonary embolism were collected at a mean age of 63years（46-73years）.Fifteen cases occurred after surgery,in which 11cases（28.6%）were malignant tumors,while 6cases developed before operation.RESULTS Nine cases complained of chest tightness,shortness of breath,and 6cases had cough,5cases with no symptom,4cases with faint,3cases with dyspnea,1case with chest pain,1case with hemoptysis.Nineteen out of 20 patients were diagnosed by CT pulmonary angiography（CTPA）.One case had negative CTPA,but her pulmonary perfusion scans showed multiple lung perfusion reduction.The other case couldn＇t get CTPA because of a history of epilepsy,who was also diagnosed by lung perfusion.After being given thrombolysis,anticoagulation,and interventional treatment,the lesions of pulmonary embolism in 20 cases dissolved,and the other case gave up treatment because of serious illness.CONCLUSIONS Clinical symptoms of pulmonary embolism are significantly different.Classic triple symptoms with dyspnea,chest pain and hemoptysis are infrequent.The main risk factor for pulmonary embolism is surgery,but it can also occur before surgery,especially in elderly patients with malignant tumors.For those who have risk factors,CTPA combined with lung perfusion scan can help early detection of pulmonary embolism.Active prevention,timely and effective treatment of pulmonary embolism after a risk assessment can significantly reduce the occurrence of perioperative pulmonary embolism.