神经系统肿瘤术后急性肺血栓栓塞的临床特点分析

Clinical characteristics analyses of pulmonary thromboembolism in post-operative patients with neurologic tumors

目的分析神经系统肿瘤术后急性肺血栓栓塞(PTE)的临床特点及危险因素,探讨肺栓塞危险度预测评分(Wells评分、Geneva评分)联合肺栓塞排除标准(PERC积分)在神经系统肿瘤术后PTE中的应用价值。方法回顾性分析首都医科大学三博脑科医院2016年6月至2019年6月收治的56例神经系统肿瘤术后、临床确诊的PTE患者的临床资料。收集患者一般情况,如患者的病案号、性别、年龄、身高、体质量、抽烟史、饮酒史、既往静脉血栓栓塞症病史、既往基础疾病史及肿瘤病理诊断,以及临床特征及辅助检查,包括临床症状、体征、围手术期临床信息、影像学检查(CT肺血管造影,CTPA)、静脉血栓危险因素等,以及治疗及转归,包括溶栓或抗凝治疗,评估入、出院时和确诊PTE时Karnofsky(KPS)评分。计算Wells评分、Geneva评分为高中低度,评定PERC积分,分析Wells评分、Geneva评分和PERC积分在神经系统肿瘤术后PTE诊断中的价值。结果56例患者中,男35例,女21例;平均年龄(46.23±18.12)岁。常见症状是呼吸困难、意识状态下降,分别占73.21%(41/56)、35.71%(20/56)。常见呼吸急促、心动过速、深静脉血栓形成(DVT)体征,分别占66.07%(37/56)、46.43%(26/56)、53.57%(30/56)。PTE出现于术后9.00(4.75,14.00)d。术前禁食水平均时间(9.50±2.82)h;从麻醉开始至麻醉清醒拔管平均时间为(683.2±295.5)min。术后病理结果显示恶性肿瘤20例(35.71%),良性肿瘤36例(64.29%)。按肿瘤发生部位分类,鞍区肿瘤26例(46.43%),幕上肿瘤21例(37.50%),颅底肿瘤7例(12.50%),脊髓肿瘤2例(3.57%)。其中,55例患者行单纯抗凝治疗,1例患者行腔静脉滤器置入术+抗凝治疗;院内死亡4例(7.14%)。所有患者Wells评分平均(7.19±1.70)分,Geneva评分平均(7.44±1.85)分,皆属于中、高危组;肺栓塞PERC积分平均(4.18±1.20)分,均为阳性病例。结论神经系统肿瘤术后出现急性PTE者基础病因复杂,临床表现无特异性;肺栓塞危险度预测评分(Wells评分、Geneva评分)联合肺栓塞排除标准(PERC积分)以及辅助实验室检查,有助于肺栓塞的早期诊断。

Objective To analyze the clinical characteristics and risk factors of patients with pulmonary thromboembolism(PTE)after operation;and explore the application value of PTE risk prediction score(Wells score,Geneva score)combined with Pulmonary Embolism Rule-Out Criteria(PERC)score in postoperative patients with neurologic tumors.Methods The clinical data of 56 patients with PTE after operation of neurologic tumors were retrospectively analyzed in Sanbo Brain Hospital of Capital Medical University from June 2016 to June 2019.Their clinical characteristics,risk factors,and laboratory examinations were analyzed,retrospectively.The general information of patients,such as medical record number,gender,age,height,body weight,smoking history,drinking history,previous venous thromboembolism history,previous basic disease history and tumor pathological diagnosis,as well as clinical features and auxiliary examinations,including clinical symptoms,signs,perioperative clinical information,imaging examination(CTPA),venous thrombosis risk factors,as well as treatment and prognosis,The Karnofsky(KPS)scores at admission,discharge and diagnosis of PTE were evaluated.The Wells score and Geneva score were calculated as high,medium and low,and PERC score was evaluated.The value of Wells score,Geneva score and PERC score in the diagnosis of PTE after operation of neurologic tumors was analyzed.Results There were 35 males and 21 females among the 56 patients,with an average age of(46.23±18.12)years.The common symptoms were dyspnea and disturbance of consciousness,accounting for 73.21%(41/56)and 35.71%(20/56),respectively.The common signs of shortness of breath,tachycardia and deep venous thrombosis(DVT)accounted for 66.07%(37/56),46.43%(26/56)and 53.57%(30/56),respectively.PTE occurred 9.00(4.75,14.00)days after operation.The average preoperative fasting time was(9.50±2.82)hours.The average time span from the beginning of anesthesia to extubation consciously is(683.2±295.5)min.Pathological results showed malignant tumor in 20 cases,accounting for 35.71%,and 36 benign tumors,accounting for 64.29%.According to the tumor location,there were 26 cases(46.43%)of sellar tumors,21 cases(37.50%)of supratentorial tumors,7 cases of skull base tumors(12.50%),and 2 cases of spinal cord tumors(3.57%).Among them,55 patients underwent anticoagulation therapy alone,and 1 patient underwent vena cava filter placement+anticoagulation therapy;4 patients(7.14%)died in the hospital.All patients had an average Wells score of(7.19±1.70)and a Geneva score of(7.44±1.85),all of which belonged to the middle and high risk groups.The average PERC score was(4.18±1.20),recognized as positive cases.Conclusions The underlying cause of acute PTE after neurological tumor surgery is complicated,and the clinical manifestations are not specific.PTE risk prediction score(Wells score,Geneva score)combined with PERC score and auxiliary laboratory tests are helpful for early diagnosis of pulmonary embolism.