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[术后肺血栓栓塞症与医院获得性肺炎:鉴别诊断]

[Postoperative pulmonary thromboembolism and nosocomial pneumonias: differential diagnosis].

作者信息

Janků K, Kepák J, Svoboda P, Kantorová I, Melichar V

机构信息

Traumatologická klinika Orazovd nemocnice, Brno.

出版信息

Cas Lek Cesk. 2007;146(1):40-4.

Abstract

After a surgical intervention patient can face pulmonary complication that was formerly recognised as postoperative pneumonia. This term described the clinical picture which was diagnosed after abdominal or thoracic operations, after polytraumatic lesions, especially with elderly patients that were for a longer time confined to bed rest. The clinical symptoms incl. the X ray picture were consistent with those of pneumonia - such pneumonias are nowadays classified as nosocomial infections. These complications sometimes ended fatally. The post-mortem examination revealed either pneumonia or often pulmonary thromboembolism (PTE). Occasionally it happened that PTE was incorrectly clinically diagnosed as pneumonia and the patient was treated with antibiotics instead of with heparin. The present paper brings discussion on the differential diagnosis between postoperative nosocomial pneumonia and PTE. Clinical casuistic is also added.

摘要

手术干预后,患者可能会面临以前被认为是术后肺炎的肺部并发症。该术语描述了在腹部或胸部手术后、多发创伤性损伤后,尤其是长期卧床的老年患者中被诊断出的临床症状。临床症状包括X线表现与肺炎一致——如今这类肺炎被归类为医院感染。这些并发症有时会导致死亡。尸检显示要么是肺炎,要么通常是肺血栓栓塞症(PTE)。偶尔会发生PTE被临床误诊为肺炎,患者接受抗生素治疗而非肝素治疗的情况。本文对术后医院获得性肺炎和PTE的鉴别诊断进行了讨论。还增加了临床病例。

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