摘要
目的外科术后急性肺栓塞(PE)是手术后高危并发症,病死率极高。文中旨在通过分析各项危险因素及抗凝治疗对术后PE转归的影响,为其防治提供临床依据。方法回顾性分析郑州大学第一附属医院2011年3月至2014年4月住院经螺旋CT肺动脉造影检查确诊为急性PE的94例患者。按照合并其他PE危险因素情况将纳入的PE患者分为A组(未合并其他PE危险因素)和B组(合并其他PE危险因素)。比较2组患者患者血栓危险因素、发病时相关检查结果[血压、呼吸频率、心率、血气分析、血清D-二聚体及B型利钠肽(BNP)结果]以及治疗方法、出血并发症、疾病转归等临床资料。结果 A组患者平均氧分压明显高于B组,差异有统计学意义[(87.36±23.06)mm Hg vs(74.43±24.7)mm Hg,P<0.05];血清BNP浓度明显低于B组,差异有统计学意义[(945.64±1 407.64)pg/m L vs(2 639.14±4 070.38)pg/m L,P<0.05]。B组抗凝治疗率明显低于A组,差异有统计学意义(90%vs 100%,P<0.05);患者死亡风险高于A组(P<0.05)。抗凝和溶栓治疗与出血并发症相关性显著(P<0.05)。抗凝治疗与病死率呈负相关(P<0.05);而患有肿瘤、BNP升高、低氧血症、低血压与病死率呈正相关(r=0.448、r=0.211、r=0.369、r=0.200,P<0.05)。结论急性PE患者外科术后抗凝、溶栓治疗与出血并发症有关。抗凝治疗可降低外科术后急性PE患者的死亡风险;而肿瘤、BNP升高、低氧血症、低血压增加此类患者的死亡风险。
Objective Postoperative acute pulmonary embolism （PE） is a high risk complication with high mortality.The aim of this study was to analyze the risk factors for postoperative acute PE and the effect of anticoagulation treatment on the complication and prognosis. Methods Ninety four postoperative patients diagnosed with acute PE by spiral CT pulmonary angiography examination from March 2011 to April 2014 were enrolled.The patients were divided into 2 groups.Group A：Postoperative patients without other risk fac-tors of PE （tumor, pregnancy/delivery, heart failure, COPD, long-term bedridden because of internal diseases , hypertension, coronary heart disease, stroke, atrial fibrillation and deep venous thrombosis of lower limb and PE history ）;Group B：Postoperative patients with other risk factors of PE .The clinical data werecollected and analyzed including the risk factors of PE , examination results when PE oc-curred （ blood pressure, respiratory rate, heart rate, blood gas analysis, the level of serum D-dimer and BNP）, method of treatment, bleeding complications and prognose . Results The oxygen pressure of group A was obviously higher than that of group B （ 87.36 ±23.06 mmHg vs 74.43±24.7 mmHg, P〈0.05）; the level of serum BNP in group A was lower than that in group B （ 945.64 ±1407.64 pg/mL vs2639.143±4070.375 pg/mL, P〈0.05）.The rate of anticoagulant therapy was significantly lower in group B than that in group A （90%vs 100%P〈0.05） .The mortality of group B was higher than that of group A （ P〈0.05） .The therapy method of anticoagulant and thromboly-sis had positive correlation with bleeding complications （ P〈0.05） .The therapy method of anticoagulant had negative correlation with the mortality of acute PE, while the tumor, increase in serum BNP increasing , hypoxemia and hypotension had positive correlation with the mortality of acute PE （P〈0.05）. Conclusion The therapy method of anticoagulant and thrombolysis can increase the risk of bleeding complications of postoperative patients diagnosed with acute PE , while the therapy method of anticoagulant can reduce the risk of death of these patients.The tumor, increase in serum BNP , hypoxemia and hypotension can increase the risk of death .
出处
《医学研究生学报》
CAS
北大核心
2017年第10期1075-1078,共4页
Journal of Medical Postgraduates
关键词
肺栓塞
外科手术
并发症
疾病转归
Pulmonary embolism
Surgical postoperation
Complications
Prognosis
