開胸術(shù)后患者發(fā)生肺栓塞的危險(xiǎn)因素分析
發(fā)布時(shí)間：2018-09-14 14:32
【摘要】：目的:肺栓塞(pulmonary embolism,PE)是指右心室或靜脈系統(tǒng)的內(nèi)外源性栓子進(jìn)入肺部循環(huán)造成肺動脈或肺動脈的分支阻塞引起肺循環(huán)及呼吸功能障礙的臨床急性綜合征,栓子可以是血栓、氣栓或羊水等等。肺血栓栓塞癥(pulmonary thromboembolism,PTE)是指來自靜脈系統(tǒng)或右心的血栓阻塞肺動脈系統(tǒng)所致,以肺循環(huán)和呼吸功能障礙為主要表現(xiàn)的綜合征。PTE是肺栓塞中最為多見的類型,平時(shí)所指的肺栓塞通常是指肺血栓栓塞癥。PTE血栓最主要的來源是深靜脈血栓形成(deep venous thrombosis,DVT),其中下肢深靜脈最為常見。肺栓塞的發(fā)病機(jī)制與深靜脈血栓形成基本一致,肺栓塞可以由下肢深靜脈血栓發(fā)展而來,可以將兩者統(tǒng)稱為靜脈血栓癥(venous thromboembolism,VTE)。肺栓塞是臨床工作中發(fā)生率僅次于心肌梗死和腦出血的常見心血管疾病。肺栓塞在手術(shù)后的發(fā)生概率較高,由于肺栓塞起病急,發(fā)病較隱匿,缺乏特異的臨床癥狀及體征,病情進(jìn)展速度快,臨床工作中常常難于早期發(fā)現(xiàn)并給予干預(yù),病死率高達(dá)20%~30%,如經(jīng)過早期干預(yù)及治療,可使肺栓塞患者死亡率明顯下降。本研究詣在探討開胸術(shù)后肺栓塞形成的原因,總結(jié)疾病相應(yīng)的危險(xiǎn)因素,在早期對患者給予干預(yù),降低肺栓塞發(fā)病率,從而改善患者手術(shù)預(yù)后。方法:回顧性分析自2008年至2016年天津市胸科醫(yī)院開胸術(shù)后發(fā)生肺栓塞的患者共44例,應(yīng)用分層抽樣選取同時(shí)期術(shù)后未發(fā)生肺栓塞的患者45例,分析、總結(jié)以上患者的臨床資料,對臨床特點(diǎn)進(jìn)行分析并進(jìn)行比較,選取性別、年齡、術(shù)后臥床時(shí)間、合并內(nèi)科基礎(chǔ)疾病、惡性腫瘤、血液高凝狀態(tài)指標(biāo)、吸煙等危險(xiǎn)因素,使用SPSS 19.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析,用x±s表示連續(xù)性計(jì)量資料結(jié)果,用率表示分類計(jì)數(shù)資料,采用χ2檢驗(yàn)單因素分類計(jì)數(shù)資料。結(jié)果:本次研究中開胸術(shù)后肺栓塞組中男性患者24例(54.5%),女性患者20例(45.5%),平均年齡60.34歲;開胸術(shù)后無肺栓塞組中男26例(57.7%),女19例(42.3%),平均年齡60.24歲;開胸術(shù)后肺栓塞組患者中出現(xiàn)胸悶氣短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%),體溫升高2例(4.5%),咯血3例(2.27%),其中臨床表現(xiàn)典型三聯(lián)癥(氣促,胸痛,咯血)1例(2.27%);開胸術(shù)后肺栓塞組中合并有糖尿病5例,合并冠心病7例,合并高血壓11例,合并基礎(chǔ)疾病的患者共23例,占52.27%;開胸術(shù)后無肺栓塞組中并有糖尿病4例,合并冠心病5例,合并高血壓8例,合并基礎(chǔ)疾病的患者共17例,占37.78%;開胸術(shù)后肺栓塞組中23例患者病理類型為腺癌,占52.2%,19例為鱗癌,占43.1%;開胸術(shù)后無肺栓塞組中13例患者病理類型為腺癌,占28.8%,11例為鱗癌,占24.4%;肺栓塞組患者中吸煙患者共31例,占70.4%,開胸術(shù)后無肺栓塞組患者中吸煙患者共20例,占22.7%;兩組患者的凝血及血液指標(biāo)通過t檢驗(yàn)分析發(fā)現(xiàn),血漿凝血酶原時(shí)間(PT)、血漿凝血酶時(shí)間(TT)、活化部分凝血活酶時(shí)間(APTT)、血漿纖維蛋白原(Fib)、血小板(PLT)、D-二聚體這些指標(biāo)的差異均無統(tǒng)計(jì)學(xué)意義(p0.05),通過單因素分析得出兩組資料在病理類型為腺癌、臥床時(shí)間大于3天、吸煙這三項(xiàng)因素上存在差異(p0.05),是開胸術(shù)后發(fā)生肺栓塞的獨(dú)立的危險(xiǎn)因素。結(jié)論:1.在本次研究的這些危險(xiǎn)因素中,肺癌是開胸術(shù)后發(fā)生肺栓塞的獨(dú)立的危險(xiǎn)因素,病理類型為腺癌的患者發(fā)生肺栓塞的幾率較合并其他類型腫瘤更高。2.臥床時(shí)間大于3天是開胸術(shù)后發(fā)生肺栓塞的另一獨(dú)立的危險(xiǎn)因素,術(shù)后及時(shí)對患者進(jìn)行正確的臥位及活動方法指導(dǎo),鼓勵早期下床活動,可以降低術(shù)后由于臥床時(shí)間延長而增加的血栓形成風(fēng)險(xiǎn)。3.吸煙同樣是肺栓塞的發(fā)病危險(xiǎn)因素,我們在臨床工作中應(yīng)該特別加強(qiáng)對吸煙患者的宣教,這不僅可以降低術(shù)后肺栓塞的發(fā)生率,同時(shí)也可以降低其他心腦血管疾病的發(fā)生率4.在臨床工作中,做到早期預(yù)防、早期診斷和及時(shí)干預(yù)治療可以有效降低術(shù)后塞的發(fā)生率以及死亡率。在合并上述危險(xiǎn)因素的患者中,如果術(shù)后出現(xiàn)突發(fā)呼吸困難時(shí)應(yīng)需特別注意發(fā)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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R563.5
本文編號：2242983
[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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R563.5
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