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1、30中国矫形外科杂志2003年1月第11卷第1期OrthopJChin,Vol.11,No.1January2003论著骨科手术后肺栓塞的诊断与治疗姚长海侯树勋文仲光张伟佳章亚东张轶超摘要目的:探讨骨科手术后肺栓塞的诊断与治疗。方法:从1998年6月~2002年4月共治疗骨科手术后肺栓塞(PE)5例,男1例,女4例。年龄40~78岁,平均63岁。手术类别:人工股骨头置换术、人工全髋置换术、右肱骨外科颈骨折内固定术、右肱骨肿瘤切除术以及多发骨折内固定术各1例。肺栓塞发生时间3~14d
2、,平均10d。诊断依据:呼吸困难和气短、动脉血气PO2下降和低碳酸血症、ECT-肺通气灌注静态显像异常等。治疗:5例均行抗凝治疗,其中3例行栓体舒(t~PA)溶栓治疗。结果:本组5例中3例诊断及时,行溶栓治疗后痊愈出院,2例抢救无效死亡。结论:必须提高对肺栓塞的认识,才能早期发现、早期治疗、减少和避免严重后果。急性肺栓塞的治疗包括溶栓治疗、抗凝治疗、介入治疗和外科手术等。肺栓塞最好的治疗还是预防。特别是预防下肢深静脉血栓的发生至关重要。关键词骨科手术;肺栓塞;溶栓中图分类号R68文献标识码A
3、文章编号1005-8478(2003)01-0030-04TheDiagnosisandTreatmentofPulmonaryEmbolismfollowingorthopaedicSurgeryYAOChang-hai,HOUShu-xun,WENZhong-guang,etal.DeparmentofOrthopaedicSurgery,the304thHospitalofthePAL,Beijing,100037AbstractObjective:Todiscussthediagnosisandtr
4、eatmentofpulmonaryembolismfollowingorthopaedicoperation.Meth-ods:FivecasespulmonaryembolismfollowingorthopaedicsurgeryweretreatedfromJune1998toApril2002,including1casemaleand4casesfemale.Theywere40to78yearsold,withanaverageof63yearsold.Theorthopaedicoperation
5、were:replace-mentoffemoralhead,arthroplastyoftotalhip,internalfixationoffractureofsurgicalneckofhumerus,tumorexcisionofhumerusandinternalfixationofmultiplefracture.Pulmonaryembolismoccurred3to14daysaftersurgery(main10days).Thediagnosisbasiswere:dyspneicrespir
6、ation,shortbreath,hypoxemia,hypocapniaandpulmonaryventilation-perfusionimbalance.AllofthesepatientswereperformedanticoagulanttherapyandthreepatientswereusedT-PA.Results:Threeofthefivepatientsrecoveredafteranticoagulanttherapyproperlyandtheotherpatientsdied.Co
7、nclusion:Earlydiscoveryandtreatmentdependedonknowledgeofpulmonaryembolism,whichplayedaimportantroleindecreaseoravoidofbadresult.Thetreatmentofacutepulmonaryembolismconsistedofanticoagulanttherapy,interventiontreatmentandsurgicalmethods,andetc.Buteffectivepre-
8、ventionwasthebesttreatment,especiallythepreventionoflowerextremityvenousembolismwasthemostimportantmeasure.KeywordsOrthopaedicSurgery;Pulmonaryembolism;Anticoagulanttherapy随着人工髋关节置换术