骨科肺栓塞死亡病例的回顾分析

Retrospective analysis of orthopaedic pulmonary embolism death cases

目的分析骨科围手术期急性肺栓塞死亡患者的临床特点。方法回顾性分析9例骨科因骨折住院、围手术期急性肺栓塞猝死患者的临床资料,探讨其临床症状、心电图、D-二聚体检测、深静脉血栓彩色多普勒超声检查的特点。结果 9例死亡病例临床表现为呼吸困难、呼吸循环骤停、心电图诊断异常(异常率100%)、血浆D-二聚体升高者3例(33.3%),彩色多普勒超声检查未发现深静脉血栓。结论骨科围手术期肺栓塞猝死患者发病急,变化快,严重程度与心电图改变正相关,D-二聚体检测以及深静脉血栓超声检查阴性者不能排除。必须综合分析,密切注视病情变化,早期防治,才能降低病死率。

Objective To analyze clinical feature of orthopaedic pulmonary embolism death in perioperative period. Methods Retrospectively analyze clinical data of 9 orthopaedic patients who came to hospital of fracture and died suddenly of acute pulmonary embolism. Exploration were made on clinical symptoms, electrocardiogram, D-Dimer detection and deep vein thrombosis of color doppler ultrasound detection. Results 9 death cases had clinical manifestation as dyspnea, respiratory circulation arrest and abnormal diagnosis of electrocardiogram（abnormal rate as 100%）, with 3 cases（33.3%） of D-Dimer rise, and no deep venous thrombosis showed after color doppler ultrasound detection. Conclusion Orthopaedic patients who died suddenly of pulmonary embolism in perioperative period are characterized by acute occurrence and swift changing, and severity is positively correlated to electrocardiogram changing. Negative patients with D-Dimer and deep vein thrombosis ultrasound detection still cannot be excluded. Comprehensive analysis, early prevention and treatment may reduce mortality.