重症监护室术后并发急性肺栓塞患者的诊疗研究

Study on diagnosis and treatment of postoperative complicating acute pulmonary embolism in ICU

目的探讨术后患者并发急性肺栓塞(APE)的诊疗方法。方法选取该院2014年7月至2016年11月重症监护室(ICU)的10例术后合并APE患者,对其临床特点、年龄、基础疾病及诊治过程进行回顾分析。结果 10例患者平均在术后第(2.4±1.1)天发生,表现为不同程度的呼吸衰竭、循环衰竭、肾衰竭、胸痛、咯血、咳嗽。5例(50%)使用阿替普酶溶栓,2例(20%)使用低分子肝素抗凝,3例(30%)使用肝素抗凝。治疗后死亡1例(10%),出院1例(10%),好转转出ICU 8例(80%)。结论术后并发APE的概率高,应评估风险、及早预防,若发生APE,采用溶栓或抗凝治疗效果好。

To investigate the diagnosis and treatment method of complicating acute pulmonary embolism（APE）after surgery in ICU. Methods Ten patients with complicating APE after surgery in ICU of this hospital from July 2014 to November 2016 were selected. Then clinical characteristics, age,basic diseases; Clinical diagnosis and treatment process were retrospectively analyzed. Results Ten cases occurred on mean postoperative（2.4 ±1.1） d, which manifested by different degrees of respiratory failure, circulatory failure, renal function failure, chest pain, hemoptysis and cough. 10% and 40% respectively. Five cases（50%） used rt-PA thrombolysis,2 cases（20%） were treated with low molecular weight heparin anticoagulation and 3 cases （30 %） were treated with heparin anticoagulation,One case（10%） died after treatment, 1 case（10%） was discharged from hospital and 8 cases （80%）were improved and discharge from ICU. Conclusion Postoperative complicating pulmonary embolism has high probability. The postoperative complicating pulmonary embolism risk should be evaluated for prevention as early as possible. If APE occurs,a-dopting thrombolysis or anticoagulation therapy has good effect.