术后急性肺栓塞患者血栓危险因素及抗凝治疗对术后并发症及转归的影响

发布时间：2018-11-05 10:04

【摘要】：目的外科术后急性肺栓塞(PE)是手术后高危并发症,病死率极高。文中旨在通过分析各项危险因素及抗凝治疗对术后PE转归的影响,为其防治提供临床依据。方法回顾性分析郑州大学第一附属医院2011年3月至2014年4月住院经螺旋CT肺动脉造影检查确诊为急性PE的94例患者。按照合并其他PE危险因素情况将纳入的PE患者分为A组(未合并其他PE危险因素)和B组(合并其他PE危险因素)。比较2组患者患者血栓危险因素、发病时相关检查结果[血压、呼吸频率、心率、血气分析、血清D-二聚体及B型利钠肽(BNP)结果]以及治疗方法、出血并发症、疾病转归等临床资料。结果 A组患者平均氧分压明显高于B组,差异有统计学意义[(87.36±23.06)mm Hg vs(74.43±24.7)mm Hg,P0.05];血清BNP浓度明显低于B组,差异有统计学意义[(945.64±1 407.64)pg/m L vs(2 639.14±4 070.38)pg/m L,P0.05]。B组抗凝治疗率明显低于A组,差异有统计学意义(90%vs 100%,P0.05);患者死亡风险高于A组(P0.05)。抗凝和溶栓治疗与出血并发症相关性显著(P0.05)。抗凝治疗与病死率呈负相关(P0.05);而患有肿瘤、BNP升高、低氧血症、低血压与病死率呈正相关(r=0.448、r=0.211、r=0.369、r=0.200,P0.05)。结论急性PE患者外科术后抗凝、溶栓治疗与出血并发症有关。抗凝治疗可降低外科术后急性PE患者的死亡风险;而肿瘤、BNP升高、低氧血症、低血压增加此类患者的死亡风险。
[Abstract]:Objective Acute pulmonary embolism (PE) after surgery is a high-risk complication and mortality is very high. The aim of this article is to provide clinical basis for the prevention and treatment of PE by analyzing the risk factors and the influence of anticoagulant therapy on the outcome of postoperative PE. Methods 94 patients with acute PE diagnosed by spiral CT pulmonary angiography from March 2011 to April 2014 in the first affiliated Hospital of Zhengzhou University were retrospectively analyzed. According to the risk factors associated with other PE, patients with PE were divided into two groups: group A (without other PE risk factors) and group B (with other PE risk factors). The risk factors of thrombus, the related examination results [blood pressure, respiratory frequency, heart rate, blood gas analysis, serum D-dimer and B-type natriuretic peptide (BNP) results] and treatment methods, bleeding complications were compared between the two groups. Clinical data such as the outcome of the disease. Results the mean partial pressure of oxygen in group A was significantly higher than that in group B (87.36 卤23.06) mm Hg vs (74.43 卤24.7 mm Hg,P0.05). The serum BNP concentration in group B was significantly lower than that in group B [(945.64 卤1 407.64) pg/m L vs (2 639.14 卤4 070.38 pg/m P 0.05]. The rate of anticoagulant therapy in group B was significantly lower than that in group A. The difference was statistically significant (90%vs 100). The risk of death was higher in group A than in group A (P0.05). Anticoagulant and thrombolytic therapy were significantly associated with bleeding complications (P0.05). There was a negative correlation between anticoagulant therapy and mortality (P0.05), but there was a positive correlation between anticoagulant therapy and mortality in patients with tumor, BNP, hypoxemia, hypotension and mortality (P 0.05). Conclusion anticoagulant therapy and thrombolytic therapy are associated with bleeding complications in patients with acute PE. Anticoagulant therapy can reduce the risk of death in patients with acute PE after surgery, while tumor, BNP, hypoxemia, and hypotension increase the risk of death in these patients.
【作者单位】：郑州大学附属郑州中心医院老年心血管内科;郑州大学第一附属医院物理诊断科;
【分类号】：R563.5

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