耳鼻咽喉科术后急性肺栓塞的临床特点及诊疗分析  

Clinical characteristics and management of acute pulmonary embolism after otolaryngology surgery

作　　者：贺璐[1] 谢静[1] 张奥博[1] 刘良发[1] 刘玉和 龚树生[1] HE Lu;XIE Jing;ZHANG Aobo;LIU Liangfa;LIU Yuhe;GONG Shusheng(Department of Otolaryngology Head and Neck Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院耳鼻咽喉头颈外科,北京100050

出　　处：《中国耳鼻咽喉颅底外科杂志》2024年第4期75-80,共6页Chinese Journal of Otorhinolaryngology-skull Base Surgery

摘　　要：目的总结耳鼻咽喉科患者术后急性肺栓塞(PE)的临床特点并分析诊疗经验。方法回顾性分析2015年1月-2022年12月在术后1个月内发生PE的耳鼻咽喉科患者的临床资料。结果PE在耳鼻咽喉科术后1个月内发病率为0.05%(12/25368),临床表现主要为呼吸困难33.3%(4/12)、心悸16.7%(2/12)、晕厥16.7%(1/12)、无症状者41.7%(5/12)。7例出现血氧饱和度/血氧分压下降,11例患者行CT肺动脉血管造影检查证实存在肺动脉或其分支的充盈缺损。2例高危及2例低危患者转重症监护治疗。11例患者抗凝治疗后有效,1例抢救无效死亡。抗凝治疗过程中3例因活动性出血停止抗凝。结论PE的临床症状不典型,需重视术后出现的呼吸困难、心悸、晕厥、血氧饱和度下降等表现。早期识别、准确判断严重程度及早期规范化治疗是改善预后的关键点。血流动力学不稳定的高危患者预后较差,需转重症监护治疗并尽早启动抗凝或溶栓治疗。Objective To summarize the clinical characteristics of postoperative acute pulmonary embolism(PE)in otolaryngology patients and analyze the the experience of diagnosis and treatment.Methods Clinical data of otolaryngology patients who developed PE within 1 month after surgery from January 2015 to December 2022 were retrospectively analyzed.Results The incidence of PE was 0.05%(12/25368)within 1 month after surgery in otolaryngology department.The primary clinical symptoms included dyspnea 33.3%(4/12),palpitation 16.7%(2/12),syncope 16.7%(1/12),and asymptomatic 41.7%(5/12).Among the 12 patients,blood oxygen saturation/arterial blood oxygen partial pressure decreased in 7,and filling defects of pulmonary artery or their branches were confirmed by CT pulmonary angiography in 11.Two patients with high-risk and two with low-risk were transferred to intensive care unit.Anticoagulation treatment was effective in 11 patients,and 1 patient died after rescue.Anticoagulation was discontinued in 3 cases due to active bleeding.Conclusions The clinical symptoms of PE are not typical,and attention should be paid to postoperative manifestations such as dyspnea,palpitation,syncope,and decrease of blood oxygen saturation.Early recognition,accurate judgment of severity and prompt standardized treatment are the key points to improve prognosis.High-risk patients with unstable hemodynamics have a poor prognosis and need to be transferred to intensive care with early initiation of anticoagulation or thrombolytic therapy.

关 键 词：耳鼻咽喉科 肺栓塞 静脉血栓栓塞 围手术期 诊疗 

分 类 号：R762[医药卫生—耳鼻咽喉科]