Fredin H O, Nillius A S
Acta Orthop Scand. 1982 Jun;53(3):407-11. doi: 10.3109/17453678208992234.
A retrospective study of fatal pulmonary embolism (FPE) was carried out in 1,324 cases of total hip replacement (THR), performed during 1969 to 1978. Dextran 70 (Macrodex 6 per cent in saline. Pharmacia AB, Sweden) was given as thromboembolic prophylaxis. Sixteen patients died within 3 months. Autopsy was performed in 14 cases. Nine died from embolism, which makes an incidence of 0.7 per cent. Autopsy was performed in 8 of these cases. Seven patients died during the second and third week. Five patients had complained of acute chest pain and 4 of them had chest radiograms taken, which were normal. Only one patient had clinical symptoms of deep vein thromboses. Perfusion lung scan was performed as a screening procedure in 3 cases, all of them showing defects typical of pulmonary embolism. Four patients died from FPE, despite heparin therapy for 3-5 days. A comparison between patients with FPE and a control group showed that premonitory attacks of acute chest pain and previous operations for orthopaedic reasons were significantly more common in patients with FPE (P less than 0.001 and P less than 0.05), respectively). No difference could be found between the groups concerning blood loss, amount of transfusion, sex, operated side, type of prosthesis and weight.
对1969年至1978年期间进行的1324例全髋关节置换术（THR）中的致命性肺栓塞（FPE）进行了回顾性研究。给予右旋糖酐70（瑞典Pharmacia AB公司生产的6%生理盐水溶液中的Macrodex）作为血栓栓塞预防用药。16例患者在3个月内死亡。对其中14例进行了尸检。9例死于栓塞，发病率为0.7%。对其中8例进行了尸检。7例患者在第二和第三周死亡。5例患者主诉急性胸痛，其中4例进行了胸部X光检查，结果正常。只有1例患者有深静脉血栓形成的临床症状。对3例患者进行了灌注肺扫描作为筛查程序，所有病例均显示典型的肺栓塞缺损。4例患者尽管接受了3 - 5天的肝素治疗，仍死于FPE。FPE患者与对照组之间的比较显示，急性胸痛的先兆发作和既往因骨科原因进行的手术在FPE患者中分别显著更常见（P小于0.001和P小于0.05）。两组在失血量、输血量、性别、手术侧、假体类型和体重方面未发现差异。
