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[术后下肢深静脉血栓形成与肺栓塞]

[Postoperative deep venous thrombosis of legs and pulmonary embolism].

作者信息

Baeshko A A, Shorokh G P, Molochko M Ia, Sheĭd A A, Klimovich V V

出版信息

Khirurgiia (Mosk). 1999(3):52-8.

Abstract

324 patients operated on the organs of abdominal cavity small pelvis and retroperitoneal space were examined by the method of I-125-fibrinogen accumulation and contrast phlebography. In 109 (33.6%) patients thrombosis of deep veins of lower extremities was diagnosed, among which in 24 cases (7.5%) it was proximal. In most cases thrombosis was predisposed by postthrombotic disease and chronic venous insufficiency of lower extremities, circulatory disturbances of the 2-3 degree, tumors, obesity, preoperative thrombophilia. Combination of 2 and more risk factors increased possibility of intravascular thrombosis. The rate of clinically registered pulmonary artery embolism (14,833 general surgical patients were avau label) made up 1.2%; in 54 (0.3%) of operated patients it was the cause of death. Postoperative lethality of embolism made up 13%. Four risk levels of development of thrombo-embolic complications were established: low (common rate of thrombosis--10.3%, proximal--1.4%, clinically evidenced pulmonary artery embolism--0.7%, with lethal outcome--0.02%), medium (28.5; 6.5; 2; 0.76%, respectively), high (80.4; 17.8; 6; 2.8%, respectively) and very high (93.3; 26.6; approximately 8; approximately 4, respectively). The prevalence of thrombo-embolic complications in patients urge surgeons and reanimatologists to carrying out prophylactic to reduce the risk of intravascular thrombosis in pre- and postoperative period.

摘要

采用I-125-纤维蛋白原积聚法和静脉造影法,对324例接受腹腔、盆腔和腹膜后间隙器官手术的患者进行了检查。诊断出109例(33.6%)患者存在下肢深静脉血栓形成,其中24例(7.5%)为近端血栓形成。在大多数情况下,血栓形成的诱因是血栓后疾病和下肢慢性静脉功能不全、2-3级循环障碍、肿瘤、肥胖、术前血栓形成倾向。两种及以上危险因素的组合增加了血管内血栓形成的可能性。临床登记的肺动脉栓塞发生率(14833例普通外科患者中有记录)为1.2%;在54例(0.3%)手术患者中,肺动脉栓塞是死亡原因。栓塞的术后死亡率为13%。确定了血栓栓塞并发症发生的四个风险级别:低(血栓形成总发生率——10.3%,近端血栓形成——1.4%,临床证实的肺动脉栓塞——0.7%,致死率——0.02%)、中(分别为28.5%;6.5%;2%;0.76%)、高(分别为80.4%;17.8%;6%;2.8%)和极高(分别为93.3%;26.6%;约8%;约4%)。血栓栓塞并发症在患者中的普遍存在促使外科医生和复苏专家在术前和术后进行预防,以降低血管内血栓形成的风险。

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