Kuroiwa Masayuki, Furuya Hitoshi, Seo Norimasa, Irita Kazuo, Sawa Tomohiro, Sasaki Junji, Ito Makoto
Department of Anesthesiology, National Hospital Organization, Sagamihara National Hospital, Sagamihara.
Masui. 2005 Jul;54(7):822-8.
Pulmonary thromboembolism (PTE) is increasingly recognized as a significant perioperative complication in Japan. A recent study reported that the incidence was 0.32 patients per 10,000 people per year in Japan. The aim of this investigation is to elucidate the incidence and characteristics of perioperative pulmonary thromboembolism in Japan.
A questionnaire was mailed to 844 institutions registered under the Japanese Society of Anesthesiologists (JSA). The survey details included age, sex, type of surgery, and risk factors of the cases operated in 2003.
Among the 844 institutions, 504 (59.7%) responded effectively. There were 440 cases of perioperative PTE in 230 institutions (45.6% of the institutions responded). The incidence of perioperative PTE was 4.76 per 10,000 cases. Massive PTE or cardiac arrest at the onset occurred in 60 cases (13.7%). Among these patients, 178 (40.5%) were obese, 162 (36.8%) had malignant diseases, and 111 (25.2%) were bed-ridden (> 4 days). The types of surgery that resulted in PTE with high frequency were "limbs and/or hip joint surgery" (9.0 per cases), "thoracic surgery with laparotomy" (7.6 per 10,000 cases), and "abdominal surgery" (6.6 per 10,000 cases). Eighty-three patients died from perioperative PTE; out of these, 9 (10.8%) died during operation, 23 (27.7%) died within 3 days after the operation, and 51 (61.4%) died 4 days after the operation. Despite having risk factors, 80 patients (33. 9%) either received unrecommended measures or did not receive any preventive measures for PTE.
The incidence of perioperative PTE is not low in Japan and is 13 times higher than the rate observed in the general population. The use of thromboprophylaxis should be considered in patients with risk factors.
在日本，肺血栓栓塞症（PTE）日益被视为一种重要的围手术期并发症。最近一项研究报告称，日本每年每10000人中PTE的发病率为0.32例。本调查的目的是阐明日本围手术期肺血栓栓塞症的发病率及特征。
向日本麻醉医师协会（JSA）登记的844家机构邮寄了调查问卷。调查细节包括2003年接受手术患者的年龄、性别、手术类型及危险因素。
在844家机构中，504家（59.7%）有效回复。230家机构（占回复机构的45.6%）共出现440例围手术期PTE病例。围手术期PTE的发病率为每10000例中4.76例。起病时为大面积PTE或心脏骤停的有60例（13.7%）。在这些患者中，178例（40.5%）肥胖，162例（36.8%）患有恶性疾病，111例（25.2%）卧床（>4天）。导致PTE发生率较高的手术类型为“肢体和/或髋关节手术”（每10000例中9.0例）、“开胸手术联合剖腹手术”（每10000例中7.6例）和“腹部手术”（每10000例中6.6例）。83例患者死于围手术期PTE；其中，9例（10.8%）死于手术期间，23例（27.7%）死于术后3天内，51例（61.4%）死于术后4天。尽管存在危险因素，但仍有80例患者（33.9%）未采取推荐措施或未接受任何PTE预防措施。
在日本，围手术期PTE的发病率不低，比普通人群中观察到的发病率高13倍。对于有危险因素的患者，应考虑使用血栓预防措施。
