妇科肿瘤术后并发肺栓塞临床分析  

Clinical analysis of complication of pulmonary embolism after operation for gynecological tumors

作　　者：张伟[1] 叶勇 杨建平[1] 陈勇[1] 郑鹏[1] ZHANG Wei;YE Yong;YANG Jian-ping;CHEN Yong;ZHENG Peng(Intensive Care Unit,Fujian Provincial Cancer Hospital,Fujian Medical University Affiliated Cancer Hospital,Fuzhou 350014,China)

机构地区：[1]福建省肿瘤医院/福建医科大学附属肿瘤医院重症医学科,福州350014

出　　处：《中国肿瘤临床与康复》2018年第11期1300-1303,共4页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的探讨妇科肿瘤术后并发肺栓塞临床病例特征。方法选取2015年8月至2018年7月间福建省肿瘤医院收治的47例妇科肿瘤术后并发肺栓塞患者,对患者临床资料、临床症状及体征、辅助检查、心电图、影像学、预防及治疗和预后进行临床分析。结果妇科肿瘤患者术后并发肺栓塞发生在术后1周,入住重症医学科,急性生理学及慢性健康状况评分系统Ⅱ(APACHE-Ⅱ)为12～42分。患者临床症状及体征、辅助检查、心电图及影像学等表现多种多样。患者均采用低分子肝素抗凝治疗,其中5例行下腔静脉滤器放置术,3例行小剂量尿激酶溶栓治疗,7例行气管插管机械通气。44例患者好转出院,3例大面积肺栓塞死亡。结论肺栓塞是妇科肿瘤术后的严重并发症,是重症医学科常见疾病之一,临床表现不典型。妇科及重症医学科医生应提高对妇科肿瘤术后并发肺栓塞的诊断意识,提高诊治率。Objective To explore the clinical characteristics of complication of pulmonary embolism after operation for gynecological tumors. Methods A total of 47 patients with complication of pulmonary embolism after operation for gynecological tumor treated at Fujian Medical University Affiliated Cancer Hospital from August 2015 to July 2018 were selected. The clinical data,clinical symptom and physical signs,adjuvant examination,electrocardiography,imaging,prevention and treatment and progonisis were analyzed. Results Pulmonary embolism occurred at 1 week after operation for gynecological tumors and were associated with ICU admission and scores of acute physiology and chronic health evaluation II（ APACHE-II） 12 to 42 points. Clinical symptoms and signs,auxiliary examination,electrocardiogram and imaging data varied among the patients. All the patients were treated with low-molecular-weight heparin（ LMWH）,5 of them were treated with inferior vena cava filter placement,3 of them were treated with lowdose urokinase thrombolysis,and 7 of them were treated with intubations and mechanical ventilation. Fortyfour patients discharged from the hospital with good health condition. Three patients died with massive pulmonary embolism. Conclusion Pulmonary embolism is a serious complication after operation for gynecological tumor. It is one of the most common diseases for which patients have to admit to intensive care unit.The clinical manifestations are lack of specificity. Gynecologists and intensivists should improve the diagnosis awareness of pulmonary embolism after operation for gynecological tumor in order to improve the diagnosis and treatment rate.

关 键 词：妇科肿瘤 重症医学科 肺栓塞 

分 类 号：R737.3[医药卫生—肿瘤]