中老年患者胸部手术后肺栓塞的防治

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1、中文摘要中老年患者胸部手术后肺栓塞的防治目的：术前综合评估中老年胸部手术后发生肺栓塞的风险，实行危险分级来进行术前和术中的临床干预，从而避免发生术后肺栓塞以及提高中老年胸部手术后肺栓塞的早期诊断及治疗水平。方法：我科在2008年1月至2012年12月共585例患者对其进行临床研究，按照临床干预措施前后分为实验组和对照组。措施：1.术前全面评估术后发生肺栓塞的风险；2.术前伴有基础疾病的治疗；3.术前的缓泻、灌肠；4.术前的双下肢血管超声检查；5.术中的精细操作；6.术后下肢血栓泵气压治疗；7.血气分析

2、的检测；8.术后减少或放弃凝血药物的使用；9.术后早期抗凝药物的使用；10.术后早期的下地活动，分别观察2组术后下肢深静脉血栓和急性肺栓塞的发生率。结果：新方案实施前，356例中男性215例，女性141例，年龄范围（49-70）岁，平均年龄63.4岁，其中发生下肢深静脉血栓26例，发生率为7.3%，发生急性PE17例，发生率为4.8%，死亡2例，死亡率为0.5%。新方案实施后，229例中男性138例，女性81例，年龄范围（48-71）岁，平均年龄65.3岁，其中未曾发生下肢深静脉血栓，发生1例PE，发

3、生率为0.4%。结论：有针对性的临床干预方案的实施降低了中老年胸部手术I后肺栓塞的发生率。关键词：中老年，胸部手术，肺栓塞，抗凝IIAbstractPreventionandcontrolofmiddle-elderlypatientswithpulmonaryembolismafterchestsurgeryObjective:Tohaveapreoperativecomprehensiveassessmentofmiddle-elders’risksofhavingpulmonaryembolis

4、mafterthoracicsurgery,thenusehazardclassificationforpreoperativeandintraoperativeclinicalintervention,therebyavoidtheoccurrenceofpostoperativepulmonaryembolismaswellastoimprovetheearlydiagnosisandtreatmentofpulmonaryembolismlevelafterthoracicsurgery.Met

5、hods:FromJanuary2008toDecember2012,ourdepartmenthadaclinicalresearchon585patients,whichwereclassifiedintoaCPM(CompoundPreventionalMeasures)andacontrolgroupinaccordancewithwhetherusingclinicalinterventions.Measures:1.Acomprehensivepreoperativeassessmento

6、ftherisksofhavingpostoperativepulmonaryembolism;2.Preoperativetreatmentwithunderlyingdisease;3.Preoperativelaxative,enema;4.BothlowerlimbsvascularUSGbeforesurgery;5.Fineintraoperativeoperation;6.Postoperativetreatmentofthrombuspumppressuretreatmentoflow

7、erlimbs;7Bloodgasanalysis;8.Reduceorabandontheuseofclottingdrugsaftersurgery;9Earlyusingpostoperativeanticoagulation;10.IIIEarlypostoperativeambulation,theincidenceofpostoperativedeepveinthrombosisandacutepulmonaryembolismintwogroupswereobserved.Results

8、:Thecontrolgroupcontains356cases,inwhich215casesweremale,141caseswerefemale,agerangewerefrom(49-70)years,themeanagewas63.4years,26caseswerefounddeepveinthrombosiswiththerate7.3%,17caseswerefoundacutePulmonaryembolismwiththerate4.