基础医学与临床 ›› 2010, Vol. 30 ›› Issue (6): 654-657.

• 临床园地 • 上一篇    下一篇

神经外科术后无症状肺血栓栓塞症的诊断及处理

魏俊吉 王任直 龚亚红 马文斌 李桂林 冯铭 窦万臣 高俊   

  1. 中国医学科学院北京协和医院神经外科
  • 收稿日期:2010-04-01 修回日期:2010-04-09 出版日期:2010-06-05 发布日期:2010-06-05

The diagnosis and treatment of silent pulmonary thromboembolism in post-neurosurgical-operative patients

Jun-ji WEI, Ren-zhi WANG, Ya-hong GONG, Wen-bin MA, Gui-lin LI, Ming FENG, Wan-chen DOU, Jun GAO   

  1. Dept. of Neurosurgery, PUMC Hospital, CAMS & PUMC
  • Received:2010-04-01 Revised:2010-04-09 Online:2010-06-05 Published:2010-06-05

摘要: 目的 研究神经外科术后的无症状肺血栓栓塞症,提高神经外科术后深静脉血栓及无症状肺血栓栓塞症的诊断及治疗水平。方法 分析我院神经外科诊断并治疗的2例无症状肺血栓栓塞症患者的临床资料,通过D-dimer,超声及CTPA进行筛查及诊断,明确诊断后予以肝素及低分子肝素抗凝治疗,后期行华发林抗凝,其中1例在抗凝治疗前急诊行下腔静脉永久滤网植入术。结果 本组D-dimer筛查结果1例正常,1例稍高于参考值上限;超声证实2例患者均有下肢静脉血栓;CTPA明确诊断为肺血栓栓塞症。抗凝治疗后复查CTPA肺血栓栓塞症有明显改善。2例患者出院后继续华发林抗凝治疗。结论 临床工作中应重视发生肺血栓栓塞症的各种危险因素,及早对高危人群进行筛查,制定围手术期的整体预防和治疗方案。

关键词: 无症状肺血栓栓塞症, 下肢深静脉血栓, 神经外科, 手术, 并发症

Abstract: Objective To study the silent pulmonary thromboembolism (SPE) and improve the management of diagnosis and treatment to the patients. Methods To analyze the clinical data of 2 cases who were diagnosed as SPE. Based on screening of D-dimer, ultrasound imaging and CTPA, the patients were diagnosed and treated initialy with low-dose heparin or low-molecular-weight heparin and then with warfarin. 1of the 2 cases had implanted permanent inferior vena cava filters before Anticoagulation. Results One of the result of D-dimer is 573μg/L(156μg/L after treatment),the other is 246μg/L(50μg/L after treatment). The ultrasound imaging showed the low extremities vein thrombosis and the CTPA confirmed the pulmonary thromboembolism. Both of them discharged after re-examinations with CTPA which showed the improvement of pulmonary thromboembolism. Conclusion The neurosurgeons should pay much attention on the high risks of SPE and screen such patients ealier. The critical thing is to make a program to prevent and treat SPE peri-operatively.

Key words: silent pulmonary thromboembolism, deep venous thrombosis, neurosurgery, operation, complication