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題名 | 手術後肺栓塞之診斷與治療 |
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作者 | 趙子健; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 19:2 1986.05[民75.05] |
頁次 | 頁96-104 |
分類號 | 416.264 |
關鍵詞 | 手術後肺栓塞; 診斷; 治療; |
語文 | 中文(Chinese) |
中文摘要 | 近年來發生下肢深靜脈血栓或肺臟栓塞的機會有逐漸增加的趨勢, 可能造成的因素包括對血栓形成的因素了解、生活水準的提升、老年及接受手術的人口增加,另外非侵犯性診斷儀器發展的進步等。血栓發生於肺臟峙,大多數患者症狀表現是突發性,因為高死亡率及復發率,所以對此類患者應保持高度警覺性,迅速診斷及治療及手術前及手術後預防措施均是非常重要的。 肺栓塞發生時,因為可能僅有非特異性症狀發生,所以確定診斷及正確治療是首先應考處問題;診斷方面除病史、胸部X光、生化檢查等外以肺灌注核子掃描(lung perfusion scan),肺換氧核子掃描(lung ventilation scan)及肺動脈血管攝影(pulmonary angiography)等是完成確定診斷的有力工具。尤其肺灌注核子掃描為非侵犯性同時具有篩檢及診斷力方能,佔有重要的地位。 治療上,藥學物方面包括肝素、鏈球茵激酶、尿素激酶等;手術方面包括下腔靜脈阻斷術及肺動脈血栓剝除術等。 我們經由肺灌注核子掃描及肺換氧核子掃描共同診斷;或經由肺灌注核子掃描及肺動脈血管攝影共同診斷;或經由肺灌注核子掃描及屍體解剖達到診斷的目的;同時患者必須接受手術後仍然住院期間發生症狀。經由上列情況下共有8例患者於1964年5月至1984年5月期間被證實手術後發生肺栓塞,經過藥物治療後,結果5例死亡,3例存活。其中1例經由脈量測定儀顯示下肢深靜脈有血栓存在。男性患者佔5例,女性患者佔3例。年齡分佈由31歲至66歲不等,平均54.8±11.4歲。茲就患者診斷治療提出報告,願能提高對手術後發肺栓塞的警覺性。 |
英文摘要 | Pulmonary embolism has a wide variety of clinical presentations to provide a major challenge to the clinician. None of these is specific, but the grouping of events may strongly suggest pulmonary embolism. Accurate diagnosis is necessary not only to insure proper treatment of patients with the disease but also to prevent inappropriate anticoagulation treatment or surgery. Diagnostic procedures have included a complete history, symptoms and signs, laboratory data, chest film. The combined lung perfusion-ventilation scan is widely acceputd as a simple, safe, sensitive method to define pulmonary embolism. However, selective pulmonary angiography is the most precise and specific technique to provide definite proof of pulmonary embolism. The primary therapeutic goal is to save the patient's life and attempt to normalize pulmonary circulation. Successful treatment of pulinonary embolism is followed by low morbidity and mortality. During the period from May 1964 to May 1984, postoperative pulmonary embolism has been proved in eight patients at the Veterans General Hospital, Shih-Pai. Three were exarnined by combined perfusion-ventilation lung scan; two patients, by lung perfusion scan and pulmonary angiography; three patients received lung perfusion scan and autopsy. All patients had received medical treatment only. Of the five male and three fernale, five patients expired and three patients survived. Postoperative pulmonary embolism is still a cause of mortality and morbidity. So early recognition with identification and prevention of the risk of a developing pulmonary embolism is vital to the patient. |
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