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目的探讨开胸术后急性肺栓塞的特点和治疗方法。方法回顾性分析开胸术后急性肺栓塞患者7例(4例为大面积肺栓塞,3例为次大面积肺栓塞)的临床特点和治疗效果。结果6例患者给予低分子肝素1mg/kg,皮下注射,每日2次;3d后加用华法令2.5mg/d,口服;当凝血酶原国际标准化比率(INR)上升至2.0-3.0后停用低分子肝素,继续华法令维持治疗。4例给予溶栓治疗:1例给予阿替普酶50mg,静脉滴注2h;3例给予尿激酶溶栓负荷量4400IU/kg,静脉注射10min,随后以4400IU·kg-1·h-1持续静脉滴注12-24h。5例患者经治疗有效,2例患者死亡。结论肺栓塞是开胸术后的严重并发症,死亡率较高,早期明确诊断、积极的抗凝和溶栓是治疗的关键。
Objective To investigate the characteristics and treatment of acute pulmonary embolism after thoracotomy. Methods A retrospective analysis of 7 patients with acute pulmonary embolism after thoracotomy (4 cases of large pulmonary embolism, 3 cases of sub-large pulmonary embolism) of the clinical features and treatment. Results 6 patients were given low molecular weight heparin 1mg / kg, subcutaneously twice a day; after 3 days with warfarin 2.5mg / d, orally; when the international standardization ratio of prothrombin (INR) increased to 2.0-3.0 after stopping With low molecular weight heparin, continue warfarin maintenance treatment. Thrombolytic therapy was given in 4 cases: one was treated with alteplase 50 mg intravenously for 2 hours; the other 3 cases received urokinase thrombolysis at a dose of 4400 IU / kg intravenously for 10 minutes followed by 4400 IU · kg-1 · h-1 Intravenous drip 12-24h. Five patients were treated effectively and two died. Conclusions Pulmonary embolism is a serious complication after thoracotomy and the mortality rate is high. Early diagnosis, positive anticoagulation and thrombolysis are the key points of treatment.