开胸术后患者发生肺栓塞的危险因素分析

发布时间：2018-09-14 14:32

【摘要】：目的:肺栓塞(pulmonary embolism,PE)是指右心室或静脉系统的内外源性栓子进入肺部循环造成肺动脉或肺动脉的分支阻塞引起肺循环及呼吸功能障碍的临床急性综合征,栓子可以是血栓、气栓或羊水等等。肺血栓栓塞症(pulmonary thromboembolism,PTE)是指来自静脉系统或右心的血栓阻塞肺动脉系统所致,以肺循环和呼吸功能障碍为主要表现的综合征。PTE是肺栓塞中最为多见的类型,平时所指的肺栓塞通常是指肺血栓栓塞症。PTE血栓最主要的来源是深静脉血栓形成(deep venous thrombosis,DVT),其中下肢深静脉最为常见。肺栓塞的发病机制与深静脉血栓形成基本一致,肺栓塞可以由下肢深静脉血栓发展而来,可以将两者统称为静脉血栓症(venous thromboembolism,VTE)。肺栓塞是临床工作中发生率仅次于心肌梗死和脑出血的常见心血管疾病。肺栓塞在手术后的发生概率较高,由于肺栓塞起病急,发病较隐匿,缺乏特异的临床症状及体征,病情进展速度快,临床工作中常常难于早期发现并给予干预,病死率高达20%~30%,如经过早期干预及治疗,可使肺栓塞患者死亡率明显下降。本研究诣在探讨开胸术后肺栓塞形成的原因,总结疾病相应的危险因素,在早期对患者给予干预,降低肺栓塞发病率,从而改善患者手术预后。方法:回顾性分析自2008年至2016年天津市胸科医院开胸术后发生肺栓塞的患者共44例,应用分层抽样选取同时期术后未发生肺栓塞的患者45例,分析、总结以上患者的临床资料,对临床特点进行分析并进行比较,选取性别、年龄、术后卧床时间、合并内科基础疾病、恶性肿瘤、血液高凝状态指标、吸烟等危险因素,使用SPSS 19.0软件进行统计学分析,用x±s表示连续性计量资料结果,用率表示分类计数资料,采用χ2检验单因素分类计数资料。结果:本次研究中开胸术后肺栓塞组中男性患者24例(54.5%),女性患者20例(45.5%),平均年龄60.34岁;开胸术后无肺栓塞组中男26例(57.7%),女19例(42.3%),平均年龄60.24岁;开胸术后肺栓塞组患者中出现胸闷气短39例(88.6%),心悸12例(27.2%),咳嗽咳痰10例(22.7%),胸部疼痛7例(15.9%),体温升高2例(4.5%),咯血3例(2.27%),其中临床表现典型三联症(气促,胸痛,咯血)1例(2.27%);开胸术后肺栓塞组中合并有糖尿病5例,合并冠心病7例,合并高血压11例,合并基础疾病的患者共23例,占52.27%;开胸术后无肺栓塞组中并有糖尿病4例,合并冠心病5例,合并高血压8例,合并基础疾病的患者共17例,占37.78%;开胸术后肺栓塞组中23例患者病理类型为腺癌,占52.2%,19例为鳞癌,占43.1%;开胸术后无肺栓塞组中13例患者病理类型为腺癌,占28.8%,11例为鳞癌,占24.4%;肺栓塞组患者中吸烟患者共31例,占70.4%,开胸术后无肺栓塞组患者中吸烟患者共20例,占22.7%;两组患者的凝血及血液指标通过t检验分析发现,血浆凝血酶原时间(PT)、血浆凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、血浆纤维蛋白原(Fib)、血小板(PLT)、D-二聚体这些指标的差异均无统计学意义(p0.05),通过单因素分析得出两组资料在病理类型为腺癌、卧床时间大于3天、吸烟这三项因素上存在差异(p0.05),是开胸术后发生肺栓塞的独立的危险因素。结论:1.在本次研究的这些危险因素中,肺癌是开胸术后发生肺栓塞的独立的危险因素,病理类型为腺癌的患者发生肺栓塞的几率较合并其他类型肿瘤更高。2.卧床时间大于3天是开胸术后发生肺栓塞的另一独立的危险因素,术后及时对患者进行正确的卧位及活动方法指导,鼓励早期下床活动,可以降低术后由于卧床时间延长而增加的血栓形成风险。3.吸烟同样是肺栓塞的发病危险因素,我们在临床工作中应该特别加强对吸烟患者的宣教,这不仅可以降低术后肺栓塞的发生率,同时也可以降低其他心脑血管疾病的发生率4.在临床工作中,做到早期预防、早期诊断和及时干预治疗可以有效降低术后塞的发生率以及死亡率。在合并上述危险因素的患者中,如果术后出现突发呼吸困难时应需特别注意发生肺栓塞的可能性。
[Abstract]:Objective: Pulmonary embolism (PE) is a clinical acute syndrome with pulmonary circulation and respiratory dysfunction caused by pulmonary artery or pulmonary artery branch obstruction caused by right ventricular or venous embolism entering the pulmonary circulation. PTE (pulmonary thromboembolism) is a syndrome characterized by obstruction of the pulmonary artery by thrombosis from the venous system or the right heart. PTE is the most common type of pulmonary embolism, usually referred to as pulmonary thromboembolism. The main source of PTE thrombosis is deep venous thrombosis. The pathogenesis of pulmonary embolism is basically the same as deep vein thrombosis. Pulmonary embolism can be developed from deep vein thrombosis of the lower extremity. They can be called venous thromboembolism (VTE). Pulmonary embolism is the second most common clinical occurrence after myocardial infarction and cerebral hemorrhage. Pulmonary embolism (PE) is a common cardiovascular disease with a high probability of occurrence after operation. It is difficult to detect and intervene early in clinical work because of its acute onset, concealed onset, lack of specific clinical symptoms and signs. The mortality rate is as high as 20%~30%. Early intervention and treatment can make PE patients die. The objective of this study was to investigate the causes of pulmonary embolism after thoracotomy, summarize the risk factors of the disease, intervene early in order to reduce the incidence of pulmonary embolism and improve the prognosis of the patients. Methods: The patients with pulmonary embolism after thoracotomy in Tianjin Thoracic Hospital from 2008 to 2016 were retrospectively analyzed. A total of 44 patients were selected by stratified sampling. The clinical data of 45 patients without pulmonary embolism at the same time were analyzed. The clinical characteristics were analyzed and compared. The risk factors of sex, age, postoperative bedtime, complications of basic medical diseases, malignant tumor, blood hypercoagulable state index and smoking were selected. SPSS was used. 19.0 software for statistical analysis, using X + s for continuous measurement results, using rate for classification and counting data, using_2 test for single factor classification and counting data. There were 26 males (57.7%) and 19 females (42.3%) with an average age of 60.24 years; 39 patients (88.6%) had chest stuffy breath, 12 patients (27.2%) had palpitations, 10 patients (22.7%) had cough and sputum, 7 patients (15.9%) had chest pain, 2 patients (4.5%) had elevated body temperature, and 3 patients (2.27%) had hemoptysis. There were 5 cases with diabetes mellitus, 7 cases with coronary heart disease, 11 cases with hypertension and 23 cases with underlying diseases in the postoperative pulmonary embolism group (52.27%), 4 cases with diabetes mellitus, 5 cases with coronary heart disease, 8 cases with hypertension and 17 cases with underlying diseases in the postoperative pulmonary embolism group (37.78%). The pathological types of the patients were adenocarcinoma (52.2%) and squamous cell carcinoma (43.1%), adenocarcinoma (28.8%) and squamous cell carcinoma (24.4%) in 13 of the patients without pulmonary embolism after thoracotomy, and smoking (70.4%) in 31 of the patients with pulmonary embolism and 20 (22.7%) in the patients without pulmonary embolism after thoracotomy. Blood indicators through t test analysis found that plasma prothrombin time (PT), plasma thrombin time (TT), activated partial thromboplastin time (APTT), plasma fibrinogen (Fib), platelet (PLT), D-dimer these indicators were not statistically significant differences (p0.05), through univariate analysis of the two groups of data in the pathological type of adenocarcinoma, Smoking was an independent risk factor for pulmonary embolism after thoracotomy. Conclusion: 1. Lung cancer was an independent risk factor for pulmonary embolism after thoracotomy in this study. The incidence of pulmonary embolism in patients with adenocarcinoma was associated with the risk of pulmonary embolism. His type of tumor is higher. 2. Bed rest time longer than 3 days is another independent risk factor for pulmonary embolism after thoracotomy. Correct lying position and exercise guidance should be given promptly after thoracotomy. Early ambulation should be encouraged to reduce the increased risk of thrombosis due to prolonged bed rest. 3. Smoking is also associated with pulmonary embolism. Risk factors, we should strengthen the clinical work of smoking patients with education, not only can reduce the incidence of postoperative pulmonary embolism, but also can reduce the incidence of other cardiovascular and cerebrovascular diseases 4. In clinical work, early prevention, early diagnosis and timely intervention can effectively reduce the incidence of postoperative obstruction. Birth rate and mortality. In patients with these risk factors, special attention should be paid to the possibility of pulmonary embolism if sudden postoperative dyspnea occurs.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.5

【参考文献】