Hanson E C, Levine F H
Ann Thorac Surg. 1982 Jun;33(6):593-8. doi: 10.1016/s0003-4975(10)60818-1.
A five-year (1975 through 1979) retrospective analysis of all cardiac surgical patients who sustained a postoperative pulmonary embolism was undertaken, and lipoprotein profiles of these patients were evaluated. Twenty-six patients (20 men and 6 women) were identified who had definite clinical, laboratory, and radiological evidence of pulmonary embolism in the postoperative period. Twenty had undergone coronary artery bypass grafting, and the remaining 6 had undergone other cardiac surgical procedures. Of the 20 patients who had coronary bypass, 19 (95%) were found to have hyperlipoproteinemia (14 patients with type II and 5 with type IV). There were 4 hospital deaths (15%), all related to pulmonary embolism. The 4 patients had undergone coronary bypass procedures, and all had type II hyperlipoproteinemia. Since patients with hyperlipoproteinemia made up less than 10% of the coronary bypass population, the incidence of pulmonary embolism in this group is highly significant (p less than 0.001). Experimental evidence has shown that patients with hyperlipoproteinemia, especially type II, have increased platelet adhesiveness and aggregation, and coagulation abnormalities consistent with a hypercoagulable state. This retrospective study clinically confirms that finding and suggests that early postoperative anticoagulation therapy may be indicated in patients with hyperlipoproteinemia, particularly type II, to reduce thromboembolic complications.
对所有术后发生肺栓塞的心脏外科手术患者进行了一项为期五年（1975年至1979年）的回顾性分析，并对这些患者的脂蛋白谱进行了评估。确定了26例患者（20例男性和6例女性），他们在术后期间有明确的临床、实验室和放射学证据证明发生了肺栓塞。其中20例接受了冠状动脉旁路移植术，其余6例接受了其他心脏外科手术。在接受冠状动脉旁路移植术的20例患者中，19例（95%）被发现患有高脂蛋白血症（14例为II型，5例为IV型）。有4例患者在医院死亡（15%），均与肺栓塞有关。这4例患者均接受了冠状动脉旁路移植手术，且均为II型高脂蛋白血症。由于高脂蛋白血症患者在冠状动脉旁路移植人群中所占比例不到10%，因此该组中肺栓塞的发生率非常显著（p<0.001）。实验证据表明，高脂蛋白血症患者，尤其是II型患者，血小板黏附性和聚集性增加，且存在与高凝状态一致的凝血异常。这项回顾性研究从临床角度证实了这一发现，并表明对于高脂蛋白血症患者，尤其是II型患者，术后早期可能需要进行抗凝治疗，以减少血栓栓塞并发症。
