论文部分内容阅读
目的探讨外科术后肺栓塞形成的病因、诊断、治疗及预防措施。方法对2006年7月至2010年9月新乡市第四人民医院外一科术后并发肺栓塞的情况进行回顾性分析。2008年9月前对术后患者未采取血栓形成预防的针对性措施;2008年9月始对大型外科手术、恶性肿瘤手术及肺栓塞形成高风险者,采用术后第3天起连续6～10d预防性应用低分子肝素。结果 2006年7月至2008年8月发生术后肺栓塞9例,7例确诊,2例误诊;误诊为心绞痛1例、胸膜炎1例,2～3d后误诊病例经肺动脉造影和肺通气灌注扫描获得肺栓塞的明确诊断。1例死亡(于发病5h猝死);8例经溶栓抗凝治疗,治愈出院。2008年9月后对术前肺栓塞评估中等风险以上、普通外科大型手术及恶性肿瘤手术的患者,术后第3天均实施预防性应用低分子肝素,再无新增肺栓塞发生。结论外科大型手术后预防性应用低分子肝素可有效防止肺栓塞的发生。
Objective To investigate the causes, diagnosis, treatment and preventive measures of pulmonary embolism after surgery. Methods From July 2006 to September 2010, the Fourth People’s Hospital of Xinxiang City, a post-surgical pulmonary embolism were retrospectively analyzed. September 2008 did not take postoperative patients thromboprophylaxis targeted measures; beginning in September 2008 for large surgery, malignant tumor surgery and pulmonary embolism formation of high risk, after the first 3 days after the continuous 6 ~ 10d prophylactic low molecular weight heparin. Results From July 2006 to August 2008, there were 9 cases of postoperative pulmonary embolism, 7 cases were diagnosed and 2 cases were misdiagnosed. One case was misdiagnosed as angina pectoris and one case was pleuritis. The patients were misdiagnosed after 2 ~ 3d and underwent pulmonary artery perfusion imaging Obtain a clear diagnosis of pulmonary embolism. 1 died (sudden death 5h); 8 patients were treated by thrombolytic therapy and were cured. In September 2008 after the assessment of preoperative pulmonary embolism in patients with moderate risk, general surgery and large surgery and malignant tumor surgery, the implementation of prophylactic low molecular weight heparin on the 3rd postoperative day, and no new pulmonary embolism. Conclusion Preoperative prophylactic use of low molecular weight heparin after major surgery can effectively prevent the occurrence of pulmonary embolism.