CAJ | 학술논문

目的探讨腹部手术后急性肺栓塞(pulmonary embolism,PE)发作的预防和诊治方法.方法回顾性分析2008年7月至2012年6月复旦大学附属中山医院青浦分院普外科腹部手术后急性肺栓塞患者病例资料.高危患者术后接受D-二聚体,下肢静脉彩超,肺动脉CTA等检查.诊断肺栓塞患者接受抗凝、全身溶栓、下腔静脉滤器置入等治疗.自2010年1月起高危患者术后接受低分子肝素预防性抗凝治疗.结果共发现PE患者8例,3例大面积PE患者死亡,5例患者接受抗凝、溶栓等治疗后好转,恢复顺利.2008年7月至2009年12月采取低分子量肝素预防性抗凝治疗前静脉血栓事件发生率为0.43％(13/3012),PE发生率为0.20％(6/3012).2010年1月后采取预防措施后静脉血栓事件发生率为0.15％ (7/4803),PE发生率为0.04％(2/4803),预防性抗凝治疗期间未发现肺栓塞病例,术后2～3周停低分子肝素后发现下肢DVT患者7例,其中伴PE患者2例.结论腹部手术后肺栓塞起病急骤,死亡率高,积极地预防、尽早诊断及治疗十分必要.
목적 탐토복부수술후급성폐전새(pulmonary embolism,PE)발작적예방화진치방법.방법 회고성분석2008년7월지2012년6월복단대학부속중산의원청포분원보외과복부수술후급성폐전새환자병례자료.고위환자술후접수D-이취체,하지정맥채초,폐동맥CTA등검사.진단폐전새환자접수항응、전신용전、하강정맥려기치입등치료.자2010년1월기고위환자술후접수저분자간소예방성항응치료.결과 공발현PE환자8례,3례대면적PE환자사망,5례환자접수항응、용전등치료후호전,회복순리.2008년7월지2009년12월채취저분자량간소예방성항응치료전정맥혈전사건발생솔위0.43％(13/3012),PE발생솔위0.20％(6/3012).2010년1월후채취예방조시후정맥혈전사건발생솔위0.15％ (7/4803),PE발생솔위0.04％(2/4803),예방성항응치료기간미발현폐전새병례,술후2～3주정저분자간소후발현하지DVT환자7례,기중반PE환자2례.결론 복부수술후폐전새기병급취,사망솔고,적겁지예방、진조진단급치료십분필요.
Objective To study the prevention,diagnosis and treatment of the pulmonary embolism after abdominal surgery.Methods The clinical data of patients with acute pulmonary embolism(PE) after abdominal surgery between July 2008 and June 2012 were analyzed retrospectively.The high-risk patients received D-dimer,deep venous ultrasound and pulmonary CT examination to confirm the diagnosis postoperatively.Anticoagulation,thrombolysis,inferior vena cava filter placement were carried out in these patients.The high-risk patients received low molecular weight heparin(LMWH) to prevent PE from January 2010.Results 5 patients with PE survived and 3 patients died.The incidence of venous thromboembolism event was 0.43％ (13/3012) before January 2010 and PE was 0.20％ (6/3012).The incidence of venous thromboembolism event was 0.15％ (7/4803) after taking preventive measures and PE was 0.04％ (2/4803).There was no PE within 1 week since using LMWH after 2010.Lower limb DVT was found in 7 patients including 2 patients with PE after LMWH discontinuance within 2-3 weeks postoperatively.Conclusions Early prevention,diagnosis and treatment of postoperative PE are important for high-risk patients.