Diagnosis And Treatment Of 19 Cases Of Acute Pulmonary Thromboembolism After Thoracic Surgery

Objective:The diagnosis and treatment of 19 patients with acute pulmonary thromboembolism after operation were analyzed.Methods:Retrospective analysis of the clinical data of 19 patients diagnosed with acute pulmonary thromboembolism during the period of thoracic surgery in the first affiliated hospital of Guangxi Medical University from January 1,2010 to September 30,2018,according to whether or not CTPA diagnosis was performed.Result:1.General information:among the 19 patients,15 were male and 4 were female,aged 57 to 77 years old,with an average age of?64.10±7.24?years old.The operation and anesthesia time was 1 to 7 hours,with an average time of?3.61±1.67?hours?P<0.05?.Acute pulmonary thromboembolism occurred 1to 7 days after surgery,with an average of?3.32±1.92?days.2.Risk stratification:there were 9 cases of high-risk pulmonary embolism,4 cases of medium-risk pulmonary embolism,and 6 cases of low-risk pulmonary embolism.3.The risk factors for patients with pre-onset concomitant diseases mainly include:4 patients older than or equal to 75 years old,19 patients with surgery history,trauma and deep vein catheterization,14 patients with malignant tumors,4 patients with deep vein thrombosis,1 patient with chronic obstructive pulmonary disease,1 patient cerebral infarction,4 patients with diabetes and 5patients with hypertension.4.Clinical manifestations:sudden dyspnea in 18 cases,chest pain in 2cases,hemoptysis in 1 case,cough in 2 cases,syncope in 5 cases,palpitation in2 cases,sweating in 5 cases,tachycardia in 7 cases,cardiogenic shock in 9 cases,respiratory and cardiac arrest in 4 cases,auscultation of lung rales in 7 cases,and pleural effusion in 18 cases.Only 1 patient had the typical triad of"dyspnea,chest pain,hemoptysis"at the same time.5.Auxiliary examination:Among the 19 patients,15 CTPA confirmed:pulmonary embolism of different degrees and different parts;Preoperative echocardiography of 17 patients:1 patient with slow pulmonary obstruction had mild pulmonary arterial hypertension,and 16 patients had no abnormalities;Echocardiography after onset:19 cases with atrial ventricular enlargement,pulmonary hypertension and tricuspid valve insufficiency;ECG:9 cases of sinus tachycardia,5 cases of atrial fibrillation,4 cases of ventricular fibrillation,3cases of ST-T changes,1 case of S_IQ_IIIT_III,and 1 case of right bundle branch block;Lower extremity vascular ultrasound:4 cases of venous thrombosis of lower extremity;Chest X-ray:small-medium-volume pleural effusion on side and/or side.Laboratory examination:In the blood gas analysis of 19 patients,14cases had oxygen partial pressure below 80 mmmHg;The D-dimer of 19patients all?500 ug/L;Preoperative coronary angiography:13 cases with no abnormalities.6.Diagnosis:14 patients were diagnosed by CTPA within 24 hours after onset.Four cases were diagnosed by clinical manifestations,blood gas analysis,d-dimer,echocardiography,electrocardiogram and preoperative coronary angiography within 24 hours after onset.One case was confirmed by CTPA 72hours after onset.7.Treatment and prognosis:among the 19 patients,9 patients with high-risk pulmonary embolism were treated with anticoagulant therapy alone,2were improved,and 2 were discharged automatically.Five patients were treated with anticoagulation and thrombolysis,4 improved and 1 was discharged automatically.In 4 cases of middle danger pulmonary embolism,all patients were discharged from the hospital after simple anticoagulant therapy.There were6 patients with low-risk pulmonary embolism,3 improved after simple anticoagulation therapy,1 was discharged automatically,and 2 died.The overall effective rate was 68.4%.8.Preventive measures:4 cases of smoking patients had a smoking ban before surgery,4 cases of diabetes patients had blood sugar level control,In 19patients,the operation and anesthesia time was shortened as much as possible,and all were resuscitated in the intensive care unit after surgery.The resuscitation process was treated with pressure.The first day after the operation,the patient was advised to get out of bed.Conclusion:1.Echocardiography has high diagnostic value for APTE and is a safe,convenient and efficient inspection method.2.Patients with APTE need not be confined to the diagnosis of CTPA.At the same time,multiple PTE-related positive results that should be highly suspicious of PTE.Anticoagulant therapy should be given first,and then CTPA diagnosis should be sought to avoid missing the best treatment opportunity.3.Attention should be paid to inpatient thrombus risk assessment,and do a good job in the treatment of primary morbidity,reducing risk factors to prevent measures.