人工关节置换术后肺栓塞8例诊断与治疗体会

Experience in diagnosis and treatment of 8 cases of pulmonary embolism after arthroplasty

目的研究人工关节置换术后患者发生肺栓塞时早期诊断治疗方法以及血气分析的价值。方法回顾性分析自2014-01—2021-12完成的2189例人工关节置换手术,术后8例发生肺栓塞,6例抢救成功(4例为全膝关节置换术后,1例为全髋关节翻修术后,1例为人工股骨头置换术后),2例死亡(1例为双侧全膝关节置换术后,1例为人工股骨头置换术后)。结果本组人工关节置换术后肺栓塞发生率为0.365%(8/2189),8例肺栓塞中7例发生在住院期间,1例发生在出院后。6例抢救成功,2例死亡。抢救成功的6例术前不吸氧的情况下测量氧分压为61~87 mmHg,平均71.17 mmHg;血氧饱和度为91%~96%,平均93.17%;氧合指数为279~353 mmHg,平均302.83 mmHg。抢救成功的6例发生肺栓塞时(不吸氧状态下测量)氧分压为48~71 mmHg,平均58.50 mmHg;血氧饱和度为79%~93%,平均88.17%;氧合指数为143~278 mmHg,平均219.17 mmHg。结论肺栓塞是人工关节置换术后患者死亡的主要原因,临床医师怀疑患者发生肺栓塞时,需及时鉴别、确诊,尽快制定治疗方案,降低术后致死率。人工关节置换术后患者的血气分析结果较术前明显降低时,结合患者临床症状可明显提高肺栓塞确诊率。

Objective To research the early diagnosis and treatment of pulmonary embolism after arthroplasty and the value of blood gas analysis.Methods A retrospective analysis of 2189 cases of artificial joint replacement surgery completed from January 2014 to December 2021 showed that 8 cases developed pulmonary embolism after surgery,6 cases were successfully rescued(4 cases after total knee arthroplasty,1 case after total hip revision,1 case after artificial femoral head arthroplasty),and 2 cases died(1 case after bilateral total knee arthroplasty,1 case was after artificial femoral head arthroplasty).Results The incidence of pulmonary embolism after arthroplasty was 0.365%(8/2189).Among the 8 cases,7 cases occurred during hospitalization and 1 case occurred after discharge.Six cases were successfully rescued and 2 died.The measured oxygen partial pressure of the 6 cases without oxygen before operation was 61-87 mmHg,with an average of 71.17 mmHg.Blood oxygen saturation was 91%-96%(mean 93.17%).The oxygenation index ranged from 279 to 353 mmHg,with an average of 302.83 mmHg.The oxygen partial pressure of 6 patients with pulmonary embolism(measured without oxygen)was 48-71 mmHg,with an average of 58.50 mmHg.Blood oxygen saturation was 79%-93%,average 88.17%.The oxygenation index ranged from 143 to 278 mmHg,with an average of 219.17 mmHg.Conclusion Pulmonary embolism is the main cause of death in patients after artificial joint replacement.When clinicians suspect that patients have pulmonary embolism,the diagnosis should made in time and the treatment plans is formulated as soon as possible to reduce postoperative mortality.The significantly lower blood gas analysis results of patients after artificial joint replacement than those before operation combined with the clinical symptoms of patients can significantly improves the diagnosis rate of pulmonary embolism.