人工关节置换术后早期无症状肺动脉栓塞的诊断及治疗  

The diagnosis and treatment of early asymptomatic pulmonary embolism after joint replacement

作　　者：王鑫[1] 陶晶[1] 唐永冬 黄擘[1] 何斌[1] WANG Xin;TAO Jing;TANG Yong-dong;HUANG Bo;HE Bin(Dept of Orthopaedics,the People′s Hospital of Shihezi City,Shihezi,Xinjiang 832000,China)

机构地区：[1]石河子市人民医院骨科,新疆石河子832000

出　　处：《临床骨科杂志》2018年第5期562-564,共3页Journal of Clinical Orthopaedics

基　　金：新疆兵团八师石河子市科技计划项目(编号:2016HZ23)

摘　　要：目的探讨人工关节置换术后早期无症状肺动脉栓塞的诊断及治疗。方法对528例行人工关节置换的患者术后早期检测D-二聚体及血气分析,如D-二聚体高于正常水平2倍以上且持续不降、血气分析提示氧饱和度显著下降,则行肺动脉CT检查有无肺动脉栓塞发生。有肺动脉栓塞患者在心电监测下皮下注射低分子肝素钠(克赛) 60 mg,q12 h,口服华法林3 mg,qd,同时隔天复查D-二聚体及凝血分析,控制INR值在2. 0～3. 0。结果 528例中47例患者术后有不同程度肺动脉小分支栓塞,但均无典型胸闷、胸痛等症状,采用以上方法治疗后均治愈。结论人工关节置换术后无症状肺动脉栓塞发生率较高,应引起重视,术后应采取及时有效的检查及治疗措施,以使患者顺利康复。Objective To investigate the diagnosis and treatment of early asymptomatic pulmonary embolism after joint replacement. Methods The 528 patients undergone joint replacement were selected, D-dimer and blood gas analysis in the early stage after operation were detected,if the D-dimer was 2 times higher than the normal level and kept the high level continuous, blood gas analysis suggested a significant decrease in oxygen saturation, pulmonary CT should be checked to exclude whether there was pulmonary embolism.If there was pulmonary embolism, 60 mg of low molecular weight heparin sodium （Clexane） should be subcutaneous injected every 12 h and oral warfarin 3 mg, qd with application of ECG monitoring ,and the D-dimer and blood gas analysis should be checked dynamicly every other day, and controlled the INR value was in 2.0~3.0. Results Of 528 cases,there were 47 patients had different degrees of pulmonary embolism with small pulmonary artery branches,and there were not typical chest tightness and chest pain syptoms.All these patients were cured after treatment through above method. Conclusions The probability of asymptomatic pulmonary embolism after joint replacement is higher,and it should be taken seriously. Timely and effective reexamin measure and treatment should be taken to cure the patients with pulmonary embolism after operation,so the patients can recover smoothly.

关 键 词：人工关节置换 无症状肺动脉栓塞 D-二聚体 肺动脉CT 

分 类 号：R687.4[医药卫生—骨科学] R543.2[医药卫生—外科学]