Josa M, Siouffi S Y, Silverman A B, Barsamian E M, Khuri S F, Sharma G V
Department of Surgery, Brockton/West Roxbury Department of Veterans Affairs Medical Center, Boston, Massachusetts.
J Am Coll Cardiol. 1993 Mar 15;21(4):990-6. doi: 10.1016/0735-1097(93)90358-8.
We examined the incidence of pulmonary embolism after cardiac surgery.
Because venous thromboembolism is considered to be an uncommon complication after cardiac surgery, its incidence was documented in a consecutive series of 1,033 patients who underwent cardiac surgery over a 5-year period.
Parallel cohorts of patients in a tertiary referral center were evaluated and the incidence of pulmonary embolism was compared in subgroups of patients undergoing coronary bypass surgery, valve surgery and combined procedures.
Pulmonary embolism developed in 33 (3.2%) of the 1,033 cardiac surgical patients, within 2 weeks of a coronary bypass operation in most; it did not develop in any patient who had isolated valve replacement surgery (p < 0.05). The diagnosis of pulmonary embolism was established by pulmonary angiography in 24 patients, ventilation/perfusion lung scan in 3, postmortem examination in 5 and clinical examination in 1 patient. Important risk factors for pulmonary embolism included prolonged postoperative recovery, obesity and hyperlipidemia. The mortality rate was 18.7% in patients with in contrast to 3.3% in those without pulmonary embolism (p < 0.01).
Although pulmonary embolism is rare after isolated valve replacement, it is not an uncommon complication after coronary bypass surgery.
我们研究了心脏手术后肺栓塞的发生率。
由于静脉血栓栓塞被认为是心脏手术后一种不常见的并发症，因此在连续5年接受心脏手术的1033例患者系列中记录了其发生率。
对一家三级转诊中心的平行患者队列进行评估，并比较接受冠状动脉搭桥手术、瓣膜手术和联合手术的患者亚组中肺栓塞的发生率。
1033例心脏手术患者中有33例（3.2%）发生肺栓塞，大多数发生在冠状动脉搭桥手术后2周内；单纯瓣膜置换手术患者均未发生肺栓塞（p<0.05）。24例患者通过肺血管造影确诊肺栓塞，3例通过通气/灌注肺扫描确诊，5例通过尸检确诊，1例通过临床检查确诊。肺栓塞的重要危险因素包括术后恢复时间延长、肥胖和高脂血症。有肺栓塞患者的死亡率为18.7%，无肺栓塞患者的死亡率为3.3%（p<0.01）。
虽然单纯瓣膜置换术后肺栓塞很少见，但冠状动脉搭桥手术后并非不常见的并发症。
