Clinical Analysis Of Pulmonary Embolism Associated With Surgery And Trauma

Objective To analyze the clinical characteristics of pulmonary thromboembolism(PTE) after surgery and trauma , elaborate the occurrence of pulmonary thromboembolism (PTE) with different surgical classification and trauma in different types in order to remind clinicians to pay more attention to the prevention of post-operational PTE and post-traumatic PTE and improve ability to diagnose early.Data and Method Clinical data from patients with 201 post-operational and 53 post-traumatic PTE hospitalized at the Affiliated Hospital of Ningxia Medical University during 2002 to 2009 were retrospectively analyzed.Results 1. Post-operational PTE,from 4 cases in 2002 up to 49 cases in 2009, the proportion of PTE patients hospitalized in the same period were 25%,23.5%;Post-traumatic PTE,from 0 case in 2002 up to 19 cases in 2009,the proportion of PTE patients hospitalized in the same period were 0.0%,9.1%。2. In surgery group,111 cases occurred within 7 days, 54 cases occurred in the second week. 29 cases occurred within 7 days and 12 cases occurred in the second week in trauma group.3. Post-operational PTE was often seen in patients after major surgical operations such as orthopedics(32.3%),hepatic surgery(14.9%), gynecological and obstetric(13.0%), gastroenteric surgery(10.9%),and medical intervention (5.5%). According to surgical classification standard , surgical classification of 201 cases is grade C(35.3%),grade A(29.4%),grade B(27.8%)and grade D(7.5%).Post-traumatic PTE was often seen in patients after major trauma such as fracture(52.8%), mixed injury(34.0%),among which lower limb fracture were 22 cases(78%).4. In surgery group ,196 cases had been treated, 189 cases received anticoagulant therapy and 9 cases received thrombolysis, only 9 cases received preventive anticoagulation. Among whom 36 cases cured, 150 cases improved, 8 cases were ineffective and 7 cases died after treatment. The case fatality ratio was 3.5%(7/201).And trauma group,50 cases had been treated, 49 cases received anticoagulant therapy and 1 case received thrombolysis,nobody received preventive anticoagulation .Among whom 23 cases cured, 26 cases improved and 3 cases were ineffective after treatment.Conclusion:1.The incidence of Post-operational PTE and Post-traumatic PTE was increased year by year.2. The First week is high-risk period of post-operational PTE and post-traumatic PTE.3.Post-operational PTE was often seen in patients after major surgical operations such as orthopedics,hepatic surgery, gynecological and obstetric, gastroenteric surgery and medical intervention; And fracture is the most common cause of post-traumatic PTE, especially lower limb fracture.4. Post-operational PTE was often seen in patients who are in grade C,grade A is in the second place.5. The clinical manifestation of post-operational PTE and post-traumatic PTE were no specificity. For clinical suspicious PTE, auxiliary examinations were helpful to diagnosis. It is crucial to improve the awareness of diagnosis and the ability of early diagnosis.6. Currently clinical physicians have low awareness of prevention ,which is the reason of the high incidence of post-operational PTE and post-traumatic PTE.