1、null nullnull S m k 姚长海null 侯树勋null 文仲光null 张伟佳null 章亚东null 张轶超null nullKnull1null “:) S m k bZE:V1998 M6 2002 M4 S m k ( PE)5 , 31 , o4 b M -40 78 , (63 b m Y: “ h a au S | =% au ? M“ #? | =% 1 bk ? 3 HW3 14d, (10dbG : 4 a PO2/ aECT-kY 9 Asb :5 ( F , 3 8 ( t PA) bT:F5 3 # H, , 2 =r b :A4k M, ?* ?Ca
2、* ah E Tb$k a F a S m bk Kz b+Y / ? 311b1oMnull S m ; nullk ; null ms |null R68 null null nullDS M null Anull null nullcI|null 1005- 8478(2003) 01- 0030- 04The Diagnosis and Treatment of Pulmonary Embolism following orthopaedic SurgerynullYA O Chang-hai, HOU Shu-xun,WEN Zhong-guang, et al. Deparment
3、 of Orthopaedic Surgery , the 304th Hospital of thePAL , Beijing, 100037Abstractnull Objective:To discuss the diagnosis and treatment of pulmonary embolism following orthopaedic operation. Meth-ods:Five cases pulmonary embolism following orthopaedic surgery were treated from June 1998 to April 2002,
4、 including 1 casemale and 4 cases female. They were 40 to 78 years old,with an average of 63 years old.The orthopaedic operation were:replace-ment of femoral head, arthroplasty of total hip, internal fixation of fracture of surgical neck of humerus, tumor excision ofhumerus and internal fixation of
5、multiple fracture.Pulmonary embolism occurred 3 to 14 days after surgery ( main 10 days) .Thediagnosis basis were: dyspneic respiration,short breath, hypoxemia, hypocapnia and pulmonary ventilation-perfusion imbalance.All of these patients were performed anticoagulant therapy and three patients were
6、 used T-PA.Results:Three of the five patientsrecovered after anticoagulant therapy properly and the other patients died.Conclusion: Early discovery and treatment dependedon knowledge of pulmonary embolism,which played a important role in decrease or avoid of bad result. The treatment of acutepulmona
7、ry embolism consisted of anticoagulant therapy, intervention treatment and surgical methods,and etc.But effective pre-vention was the best treatment, especially the prevention of lower extremity venous embolism was the most important measure.Key wordsnull Orthopaedic Surgery; null Pulmonary embolism
8、; null Anticoagulant therapyT:b +304D + S ,null 100037Te:-Z( 1947-) , 3, C , D =bZ_: ha ?bnull null “ 1 7Z, h m (DVT)94p Ypb,k (pulmonary embolism, PE) S m ,+Y 1 m ? 3 q , :CbyN, “ - S jb SV1998 M6 2002 M4 S m k ( PE) 5 b1D 8b1 null ZE1.1 nullB F5 31 , o4 b M -40 78 , (63 b5 (g 8;2 Uh N; 1 7 h Nb m
9、Y: “ h 1 ; 1 ;u S |a, =% 1 ;u M ?M“a| aD%O%1 ;P a # =3 M7 =% 1 bk ? 3 HW3 14d, (10dbF52 1 m sY -1d 10d ? / X (H v ) A40mg1Q; 3 F b1.2 nullh 1.2.1 null 1, o, 71 ,2001 M104 y“ | b; Uh N8 Mb -VO e8 9 mmol/L,g 8b2001 M1023 null30nullS Snull 2003 M111 1 null Orthop J Chin, Vol.11, No.1 January 2003“ h b
10、-1da 10d ? / X (H v) A40mg 1Qb m HW1h, 200ml, 18300mlb 3dl C a U , PO254.7mmHg,PCO243.6mmHg,839. 2null , r110Q/min, 23Q/min,135/ 90mmHgbECT-k9 A,h _5 5 10min,/ U64T c99mMAA185MBq(5mci) , /#A,10min“ -aaPaa|aP|bk9Vn2 b u,sY =U - ,kY AT Mb4 Uk =U - 9 , I nk V ?v(m1)b2001 M1027 8 ( t-PA) b Ua ,ECT-k9 A4
11、 UkY Ans(m2)b1126 bnull nullm1null ECT-k9 A Vnk =U - 9 ,4 UkUa - bm2null ECT-k9 Ab1.2.2 null 2 null o, 65 ,2001 M1214 yu S | b;a 7 # Uhh Nbg8(890kg) ,2001 M1217 ,a X f =% b 3dC 4, PO254mmHg.PCO244mmHgbm UST Mb n Asb2001 M1221 ECT-k9 A Vn? # ,k VC(m3 )b1223 8 brT , Ab1225 ECT-k9 AX(m3/)b ?F ,i b2002
12、M124 bm3null : ECT-k9 A Vn?# ,k VCb/: 1223 ECT-k9 AXb2 nullnullTF5 3 # H, , 2 =r b 2 1 ; Fa3h# 5e0h N, 21 M -SVk M“ b 12dl C a 4b h = S2L 5e03h?,b a0#_ a 12h b F ,B $k bN HXd,) V aKT, =r b 61 P b -1d 10d ? / X (H v ) A40mg 1Qbm 7d CP/n, I n ( DVT) , a a 3a E # b?/17 HC 4aa U aQb q120Q/ min, 26Q/min,
13、k Ab$ PO244mmHg null PCO273mmHg,4 Unull b$mA Unull i.E, 18:30 aKT, =rb ) yk $ b3 null)null 3. 1 null S m k ? 3 q#By k u M ?M“aD%O% ? | a a =3 M 7=% b1Yy ,D o, 3null o= 1null3;F5 31 , o4 b M -y ,D o40 60 z?, 370 z?b1 -8 ( body mass index; BMI) ,g (BMI 26 30)? 3 q3. 8%,g (BMI 30)? 3 q8. 3%bF5 3 g 8byN
14、,g ? 3k By B 4b 6,;a3ha Uha 7 %9 By BbF5 3 Uh, 2 3h, 7 ?1 b3. 2 nullk 3. 2. 1 null “5vsk “5i, “5 k PbyN,A4k M, H Y4;, ?* ?Ca* ah E TbF 3 = S2L “5T HW ,k ? jbC 4 H,X; 5e07 b12h HF, k HX =b ,k 4 89. 7%,ea 86. 8%, U 60.0%,33. 3%,i Mp28. 8%,525. 0%, F y80. 0%,?60. 6%, X41. 4%4bF5 ( 4aea F ybyN, C H1Xk V
15、 ?b3. 2. 2 null_k XL VC #k vak uk ,k HC 9bmA U9Fb 2mA Uk 9 z, i v# iWPMb k H V# 0b A UPO2/ b i_ D-dimer 6 5bF5 1 XL VC#k vak7Yi9F; 2 ms; 5 (PO2/; 4 ; 1 PCO2 6( null )byN,_PO2/ il, S Ib3. 2. 3 null _,b kA h L_ZE,kY k9AM V4k Nb3. 3 nullk $k a F a S m bv vk (V2k=5), 7 ,F3 7 b |, g F, 1 2 F,* ? b1.4 nul
16、lT | ) , z,V ? , ? (,2 | M 1 MHW =eVC,) ,9b2 null)null T ,i?rb! _ ? = W,|s3 W i,7W i$! s -2W ib W i +bB , W i) &8K/, 7, 4 s ,7 O id ,7Y_ ),# ? 3 W i8b s*,! |a# o ,W i = 6,73 E3 % ,“ 5 * s 1b # H“,| - u , 1* m ) b yp* M 7 h, !1 =3Z_-Znullanull! hW M g, Vu 7! W#bTYV7 , = M 7h , Te,) HW 7 O# Hr,1+ yHq, a Hq/ = , a H, Vr ii ?b( l: 2002-08- 13null:2002-09- 10)null33nullS Snull 2003 M111 1 null Orthop J Chin, Vol.11, No. 1 January 2003
