手術後肺栓塞─八個病例分析

肺栓塞的發生，逐漸被重視，由於生活水準提高，老年人口增加及重大手術的施行，都增加了肺栓塞發生的機會。而非侵犯性診斷工具的進展，加上只療方式的研究，使得原本復發率，死亡率高的疾病，在早期診斷，早期治療的原則下，獲致令人驚喜的進展。對於接受手術後的病人，一旦發生肺栓塞，更增加病人的危險性。身為外科醫生更應保持警覺性來面對它。手術後病發生肺栓塞時，臨床症狀也許病不明顯，必須配合胸部X光，心電圖，生化檢查。以及更進一步的確定診斷─肺灌注核子掃描〈lung perfusion scan〉，肺換氣核子掃描〈lung ventilation scan〉，及肺動脈血管攝影〈pulmonary angiography〉。治療上，在重度栓塞時，以血栓溶解劑或肺動脈血栓剝除術治療。再配合抗凝血劑或下腔靜脈組斷術來預防復發性栓塞的產生。本院從民國71年9月開幕至75年10月，其間共進行了37,233次重大手術。共有8位肺栓塞之病例被診斷出來，發生率為0.02%。診斷方式有7位是依臨床表現加上肺灌注及通氣核子掃描。另一位是肺灌注及通氣核子掃描及肺動脈血管攝影共同證實。總共有兩為死亡，占25%。有3位接受抗凝血劑或尿素激酶〈urokinase〉治療。5例沒有特殊治療者包括2例死亡，2例懷疑脂肪性栓塞及一例植物人。6例存活者，皆得到完全之痊癒。發生時間，最快者於手術當中發生，大多術在手術後一週內。超過一個月發生者，都屬長期臥床者。茲將八例患者整理報告，供大家參考。

關鍵字

無資料

並列摘要

The incidence of pulmonary embolism has been increasing due to general material progress, the increase in the aged population and the higher incidence of major operations. The development of noninvasive diagnostic tools and studies on therapy have significantly reduced the recurrence and mortality rate of pulmonary embolism. As surgeons, we should be more alert to this disease because of the increasing risk to postoperative patients. Clinical symptoms and signs of this disorder are usually subtle and several examinations including chest X-ray, ECG, biochemistry, lung perfusion-ventilation scans or pulmonary angiography, may be needed for definite diagnosis. As for therapy, thrombolytics or pulmonary embolectomy are used for the severe pulmonary embolism, while anticoagulants or vena caval interruption may effectively prevent the embolism. Eight cases (0.02%) of postoperative pulmonary embolism were encountered in our series of 37,233 major operations performed at VGH-Taichung from Sept. 1982 to Oct.1986. Of these seven cases of pulmonary embolism were proved by lung ventilation-perfusion scans, the other one was confirmed by lung ventilation-perfusion scans and pulmonary angiography. Two patients received anticoagulants therapy, and one patient was treated with urokinase only. Of the five patients who did not receive any special form of treatment, two died (25%), two were suspected of having fat embolism, and one was in a vegetation state. The six surviving patients all reported complete remission. Most of the incidences occurred postoperatively within one week. With the earliest occurring during surgery. Those month after operation or later were all bedridden patients. Early diagnosis and treatment still remain the most effective principles in the management of pulmonary embolism.

並列關鍵字

99m Tc-MAM perfusion scan ； Se-133 ventilation scan ； pulmonary embolism

國際替代計量

手術後肺栓塞─八個病例分析

全文下載

主題瀏覽