文章摘要
周晶,芮萌,陈晓红,李悦.头颈肿瘤术后急性肺栓塞患者抗凝治疗的临床分析[J].中国临床保健杂志,2020,23(6):835-838.
头颈肿瘤术后急性肺栓塞患者抗凝治疗的临床分析
Clinical analysis of anticoagulant therapy in patients with acute pulmonary embolism after operation for head and neck tumors
投稿时间:2020-05-15  
DOI:10.3969/J.issn.1672-6790.2020.06.028
中文关键词: 肺栓塞  头颈部肿瘤  耳鼻喉外科手术  抗凝药
英文关键词: Pulmonary embolism  Head and neck neoplasms  Torhinolaryngologic surgical procedures  Anticoagulants 〖FL
基金项目:
作者单位E-mail
周晶 首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,耳鼻咽喉头颈科学教育部重点实验室首都医科大学,北京 100730 rmxc1102@sohu.com 
芮萌 中国人民解放军总医院第六医学中心干部呼吸科 rmxc1102@sohu.com 
陈晓红 首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,耳鼻咽喉头颈科学教育部重点实验室首都医科大学,北京 100730 rmxc1102@sohu.com 
李悦 首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,耳鼻咽喉头颈科学教育部重点实验室首都医科大学,北京 100730 rmxc1102@sohu.com 
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中文摘要:
      目的 探讨头颈肿瘤术后合并急性肺栓塞的临床特点及抗凝治疗的效果。方法 回顾性分析2015年1月至2019年12月诊治的28例头颈恶性肿瘤术后并发急性肺栓塞患者的临床资料,总结肺栓塞的发病特点、临床表现、诊疗及预后。结果 本组经CT肺动脉造影(CTPA)首次确诊为急性肺栓塞的28例患者,占同期头颈恶性肿瘤手术的0.31%,男性21例,女性7例;年龄(65.2±10.2)岁(范围:44~82岁);手术时间(5.6±2.4)h(范围:3~11 h);肺栓塞发生时间为术后(48.2±37.5)h(范围:6~168 h),中位数为39 h;急性肺栓塞患者集中发生在术后第1~4天(93%)。临床高度怀疑急性肺栓塞时,病情允许下,在待诊断过程中积极应用预防量低分子肝素治疗。经CTPA确诊后,低分子肝素联合华法林抗凝治疗16例,低分子肝素联合利伐沙班片抗凝治疗12例。抗凝过程中术区并发出血2例,出血量30~50 mL,无其他并发症,抗凝治疗3~7 d后,患者临床症状均得到缓解,所有患者术后14~21 d出院,中位数为17 d。结论 头颈肿瘤术后肺栓塞治疗的关键是早发现,及时抗凝治疗是安全有效的。
英文摘要:
      Objective To investigate the clinical characteristics and the effect of anticoagulant therapy of acute pulmonary embolism after head and neck tumor surgery.Methods The clinical data of 28 patients with acute pulmonary embolism after head and neck cancer surgery from January 2015 to December 2019 were retrospectively analyzed,and the characteristics,clinical manifestations,diagnosis,treatment and prognosis of postoperative pulmonary embolism were summarized.Results In this study,28 patients were first diagnosed with acute pulmonary embolism by CT pulmonary angiography (CTPA),accounting for 0.31% of all head and neck malignant tumor surgeries within 5 years,including 21 males and 7 females.The average age of the patients was (65.2±10.2) years (44-82 years).The mean operation time was (5.6±2.4) hours (3-11 hours).Pulmonary embolism occurred in the postoperative (49.2±36.5) hours (6-168 hours),and acute pulmonary embolism occurred in the postoperative 1-4 days (93%).When acute pulmonary embolism was highly suspected clinically,LMWH treatment was actively applied before CTPA return.After CTPA diagnostic,LMWH was combined with warfarin anticoagulation to treat 16 cases,and LMWH was combined with rivaroxaban anticoagulation to treat 12 cases.There were 2 cases of bleeding (30-50 mL) in the operative area during anticoagulation treatment,and no other complications were found.After 3-7 days of anticoagulant treatment,the patients′ clinical symptoms were relieved;all the patients were discharged after 14-21 days of anticoagulant treatment,and the median was 17 days.Conclusion Early detection is the key to postoperative pulmonary embolism treatment for head and neck tumors,and timely anticoagulation therapy is safe and effective.
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