目的 总结肺栓塞(pulmonary embolism,PE)患者的特点,提高胸外科患者术后并发症的诊断与治疗水平。 方法 回顾性分析上海交通大学附属胸科医院2007年6月至2008年10月收治术后肺栓塞患者22例的临床资料,其中中高危肺栓塞8例,男5例、女3例,平均年龄63.5 (55~76)岁,肺癌5例,食管癌1例,纵隔肿瘤1例,慢性炎性肉芽肿1例,均行溶栓治疗;低危肺栓塞14例,男 11例、女 3例,平均年龄61.7 (55~75)岁,肺癌9例,食管癌5例,均行抗凝治疗。 结果 中高危患者中7例症状在24 h内明显改善,均痊愈出院,随访3个月无复发;1例24 h内好转,48 h后出现严重的肺部感染,并于5 d后死亡。14例低危患者均于治疗3~5 d后氧合改善,随访3个月无复发。 结论 胸外科患者术后肺栓塞的诊断仍较为困难;溶栓治疗是中高危肺栓塞患者的首选治疗方案;深静脉血栓(deep vein thrombosis,DVT)形成是术后肺栓塞的高危因素,应高度重视。
Citation:
余开颜,李赛琪,李俊,祝敏芳,吴乾,杨敏. 胸外科患者术后肺栓塞的诊断与治疗. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(1): 119-120. doi:
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Campbell IA, Bentley DP, Prescott RJ, et al. Anticoagulation for three versus six months in patients with deep vein thrombosis or pulmonary embolism,or both:randomized trial. BMJ, 2007, 334 (7595): 674.
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- 1. White RH. The epidemiology of venous thromboembolism.Circulation, 2003, 107 (23 Suppl 1): I4-I8.
- 2. Senders ZJ, Zussman BM, Maltenfort MG, et al. The incidence of pulmonary embolism (PE) after spinal fusions. Clin Neurol Neurosurg, 2012, 114 (7): 897-901.
- 3. Auer RC, Schulman AR, Tuorto S, et al. Use of helical CT is associated with an increased incidence of postoperative pulmonary emboli in cancer patients with no change in the number of fatal pulmonary emboli. J Am Coll Surg, 2009, 208 (5): 871-878.
- 4. Wang Z, Pei C, Ma L, et al. Acute pulmonary embolism after pneumonectomy. J Thorac Dis, 2012, 4 (1):76-82.
- 5. Kostadima E, Zakynthinos E. Pulmonary embolism: pathophysiology, diagnosis, treatment. Hellenic J Cardiol, 2007, 48 (2):94-107.
- 6. Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J, 2008, 29 (18): 2276-2315.
- 7. Zhang K, Zeng X, Zhu C, et al. Successful thrombolysis in postoperative patients with acute massive pulmonary embolism. Heart Lung Circ, 2012, pii:S1443-9506 (12): 01260-01262.
- 8. Tapson VF. Thrombolytic therapy in acute pulmonary embolism. Curr Opin Cardiol, 2012, 27 (6): 585-591.
- 9. 王乐民, 魏林, 主编. 肺栓塞与深静脉血栓形成. 北京:人民卫生出版社, 2007. 63-75..
- 10. Campbell IA, Bentley DP, Prescott RJ, et al. Anticoagulation for three versus six months in patients with deep vein thrombosis or pulmonary embolism,or both:randomized trial. BMJ, 2007, 334 (7595): 674.