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目的分析心血管介入术后急性肺栓塞患者的临床特点及其相关的危险因素,并进行预防和处理。方法选取2008年1月—2013年1月在我院行心血管介入术后急性肺栓塞患者28例,统计所有患者的临床表现、检查方法、治疗及临床效果等。结果患者主要表现为咳嗽15例(51.8%)、咯血9例(31.1%)、呼吸困难26例(92.7%)、心跳加快2例(8.2%)、胸痛20例(71.2%)、低血压17例(59.9%)、晕厥7例(25.3%)、下肢深静脉血栓20例(72.7%);检查方法主要有心电图28例(100.0%),15例(53.6%)患者出现改变;心脏超声28例(100.0%),26例(92.9%)患者出现明显改变;动脉血气28例(100.0%);胸片22例(78.6%);肺动脉造影7例(25.0%),患者均出现肺段充盈缺损;肺动脉磁共振8例(28.6%),患者均出现异常;放射性核素显像检查18例(64.3%),提示患者均出现肺栓塞;治疗方法有溶栓治疗:应用肝素、华法林进行抗凝治疗,防止患者血小板发生聚集;补液治疗;同时对低血压患者进行升压处理并进行相关的脱水、抗心律失常、抗感染、吸氧等对症治疗。经过治疗,2例患者死亡,26例患者病情好转。结论心血管介入术后急性肺栓塞患者病情危重,必须及时处理,采取有效的预防和治疗措施可取得较好的临床效果。
Objective To analyze the clinical features and related risk factors of patients with acute pulmonary embolism after cardiovascular intervention and to prevent and treat them. Methods Twenty-eight patients with acute pulmonary embolism after cardiovascular intervention from January 2008 to January 2013 in our hospital were enrolled in this study. The clinical manifestations, examination methods, treatment and clinical effects of all patients were statistically analyzed. Results The main manifestations were cough in 15 cases (51.8%), hemoptysis in 9 cases (31.1%), dyspnea in 26 cases (92.7%), rapid heartbeat in 2 cases (8.2%), chest pain in 20 cases (71.2%) and hypotension (59.9%), syncope in 7 cases (25.3%) and deep venous thrombosis in 20 cases (72.7%). There were 28 cases (100.0%) in ECG and 15 cases (53.6% (100.0%), and 26 (92.9%) patients had obvious changes. Arterial blood gas was found in 28 cases (100.0%), chest radiograph in 22 cases (78.6%) and pulmonary arteriography in 7 cases (25.0% 8 cases (28.6%) had pulmonary arterial magnetic resonance (MRI), and all patients showed abnormalities. Radionuclide imaging examination showed 18 cases (64.3%), which indicated that all patients had pulmonary embolism. Thrombolytic therapy was used: heparin, warfarin Anticoagulant therapy to prevent platelet aggregation in patients; rehydration therapy; at the same time for patients with hypotension pressure treatment and related dehydration, anti-arrhythmia, anti-infection, oxygen and other symptomatic treatment. After treatment, 2 patients died and 26 patients improved. Conclusions Patients with acute pulmonary embolism after cardiovascular intervention are in critical condition and must be dealt with in time. Effective preventive and curative measures should be taken to achieve better clinical outcomes.