神经外科术后肺血栓栓塞症的诊治  

Management of Pulmonary Thromboembolism in Post-operative Neurosurgical Patients

作　　者：魏俊吉[1] 龚亚红[2] 王任直[1] 马文斌[1] 杨义[1] 许志勤[1] 幸兵[1] 李永宁[1] 李桂林[1] 姚勇[1] 黄宇光[2] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院神经外科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院麻醉科,北京100730

出　　处：《中国医学科学院学报》2010年第3期332-335,共4页Acta Academiae Medicinae Sinicae

摘　　要：目的总结神经外科术后肺血栓栓塞症(PTE)的诊治经验。方法回顾性分析2009年10月至2010年3月在北京协和医院神经外科发生术后PTE的7例患者的临床资料。结果 7例患者中,6例经CT肺动脉造影(CTPA)确诊,1例根据临床表现及其他辅助检查确诊。所有患者先期行肝素或低分子肝素抗凝治疗,后期行华发林抗凝,其中2例在抗凝治疗前行下腔静脉永久滤网植入术。1例在抗凝治疗后第4天死于肺栓塞引起的呼吸循环衰竭,6例临床症状明显好转后出院。结论要重视神经外科患者围手术期发生PTE的诸多高危因素,必要时术后及时行CTPA检查,并据情况进行相应的正规抗凝治疗及采取其他必要措施。Objective To summarize the diagnosis and treatment of pulmonary thromboembolism(PTE) in post-operative neurosurgical patients.Methods We retrospectively analyzed the clinical data of 7 patients who experienced pulmonary thromboembolism after neurosurgical operations in our department from October 2009 to March 2010.Results Of these 7 patients,6 were confirmed with computed tomographic pulmonary angiography(CTPA) and 1 was diagnosed according to the clinical manifestations and other diagnostic examinations.All the patients were treated initially with low-dose heparin or low-molecular-weight heparin and then with warfarin.Two patients were implanted with permanent inferior vena cava filters before anticoagulation.One received anticoagulant therapy and died of respiratory failure due to pulmonary embolism on the fourth post-operative day.Six patients were discharged after significant improvement.Conclusions Many risk factors may cause PTE peri-operatively.Post-operative CTPA may be indicated.Anticoagulation and other management strategies may be applied to improve the outcome.

关 键 词：肺血栓栓塞症 下肢深静脉血栓 神经外科 手术 并发症 

分 类 号：R651.1[医药卫生—外科学]