ObjectiveTo summarize the treatment measures and experience for one patient with acute pulmonary thromboembolism after modified radical mastectomy for breast cancer. MethodsThe discussion on MDT (multi-disciplinary team) of a breast cancer patient admitted to The First Hospital of Lanzhou University in March 2018 and the results of the discussion on acute pulmonary thromboembolism after operation were summarized. ResultsThis patient had many high risk factors for deep venous thrombosis of the lower extremities, such as obesity, advanced age, hypertension, malignant tumor, and surgical stress. The operative time was about 90 min and the blood loss was 30 mL, without nerve and vascular injuries. Acute pulmonary thromboembolism occurred suddenly on 10 days after operation, which led to heart failure. Eventually, the patient died of the peripheral circulatory insufficiency caused by respiratory failure and heart failure. ConclusionSurgeons should pay great attention to the perioperative management of the patients with many high-risk factors, who may occur acute pulmonary thromboembolism caused by deep venous thrombosis of lower limbs after radical mastectomy.
Objective To investigate the risk factors, clinical characteristics and prognostic factors of venous thrombosis (and pulmonary embolism) in patients with idiopathic hypereosinophilia (IHE) so as to provide a theoretical basis for clinical prevention of venous thrombosis and improve prognosis.Methods Thirty-nine patients with IHE admitted to West China Hospital of Sichuan University from January 2010 to January 2022 were collected in this retrospective case-control study to explore the risk factors of venous thrombosis (including pulmonary embolism) and thrombosis recurrence after treatment. Results There were 17 (43.5%) patients combined with venous thrombosis of 39 patients with IHE. In the patients with vascular involvement, pulmonary embolism was the initial expression of IHE accounted for 29% (5/17). patients of IHE with pulmonary embolism were younger [44 (24.5 - 51.0) vs. 56 (46.3 - 67.8) year, P=0.035] and had higher peak absolute eosinophil counts [11.7 (7.2 - 26.5)×109/L vs. 3.8 (2.9 - 6.7)×109/L, P=0.020] than those without pulmonary embolism. After a mean follow-up of 13 months (2 - 21 months), thrombosis recurred in 35.3% (6/17) of patients. Persistent increasing in eosinophils (>0.5×109/L) was an independent risk factor for thrombus recurrence (odds ratio 13.33, 95% confidential interval 1.069 - 166.374). Conclusions Thrombosis is a common vascular impaired complication in IHE , and increased eosinophilia is a risk factor for thrombosis and thrombus recurrence after therapy. Controlling and monitoring the eosinophilic cell levels in patients with IHE may avoid severe comorbidities.
Objective
To explorer the application value of the inferior vena cava filter (IVCF) implantation in the prevention of recurrent pulmonary embolism (PE).
Methods
Clinical data of 265 inpatients with PE admitted from November 2014 to November 2016 were retrospectively analyzed. The patients were divided into an IVCF treatment group (55 cases) and an anticoagulant therapy group (210 cases) according to treatment measure. All patients were followed up for 3 months to 2 years through regular review. The one-year PE and deep vein thrombosis (DVT) recurrence rates, one-year mortality and two-year mortality were compared between two groups.
Results
The PE and DVT recurrence rates were 9.1% and 21.8% in the IVCF treatment group, and were 18.6% and 11.0% in the anticoagulant therapy group, respectively. The PE recurrence rate was lower and the DVT recurrence rate was higher in the IVCF treatment group compared with the anticoagulant therapy group, the differences were statistically significant (P<0.05). The one-year mortality (29.1% vs. 12.9%) and two-year mortality (34.5% vs. 14.8%) were significantly higher in the IVCF treatment group than those in the anticoagulant therapy group (P<0.05).
Conclusions
IVCF without anticoagulation can reduce incidence of pulmonary embolism caused by the lower extremity DVT, but will increase DVT recurrence rate. It may be an alternative option for prevention of PE in patients with contraindications to anticoagulant therapy or recurrent PE patients after regular anticoagulant therapy.
ObjectiveTo investigate therapeutic strategy of acute pulmonary embolism.
MethodsClinical data of 48 patients with acute pulmonary embolism who were treated in Affiliated Hospital of North Sichuan Medical College form January 2009 to May 2014 were analyzed retrospectively.
ResultsOf the 48 cases, 14 cases of low risk (low risk group) were treated with anticoagulation, 24 cases of middle risk (middle risk group) were treated with anticoagulation and systematic thrombolysis or interventional therapy (local thrombolysis after thrombus fragmentation or thrombolytic catheter placement in pulmonary artery), 10 cases of high risk (high risk group) were treated with anticoagulation and interventional therapy. In low risk group, 12 cases (85.7%) were cured and 2 cases (14.3%) were markedly effective, and total effective rate was 100%. In middle risk group, 16 cases (66.7%) were cured and 8 cases (33.3%) were markedly effective, and total effective rate was 100%. In high risk group, 1 case died, 3 cases were cured, 2 cases were markedly effective, and 4 cases were better, and the total effective ratio was 9/10. All cases suffered from no complication such as hemorrhage of cerebral and digestive system. Forty-eight cases were followed up for 3-12 months, with a median time of 8 months. During the follow-up period, there was no complication occurred such as dyspnea, pulmonary embolism, placement change of filter net, and thrombosis.
ConclusionsCorresponding therapeutic strategy would be taken according to risk stratification of the acute pulmonary embolism.
Objective
To summarize the general situation of perioperative venous thromboembolism (VTE) and summarize the perioperative antithrombotic strategies.
Methods
Domestic and international literatures and guidelines on antithrombotic therapy were collect and reviewed.
Results
VTE was common during the perioperative period. Reasonable assessment of each patient’s condition during the perioperative period, as well as reasonable use of anticoagulant, antiplatelet drugs, and hemostatic agents could reduce the incidence of VTE events during the perioperative period.
Conclusions
Clinicians need to properly assess the timing of the usage and discontinuation of antithrombotic drugs, weigh the risk of thrombosis and bleeding, develop a rational and scientific antithrombotic strategy based on the specific circumstances of each patient. Simultaneously, hemostatic agents need to be prescribed perioperatively to reduce the incidence of thromboembolic complications.
摘要:目的： 分析肺動脈血栓栓塞癥（PTE）的臨床特征、診斷方法及治療。提高診斷率和治愈率,改善預后。 方法 ：回顧分析我院過去七年間收治的25例PTE患者的危險因素、臨床表現、輔助檢查、治療情況等臨床資料。 結果 ：PTE的危險因素有深靜脈血栓、高齡、心肺疾病、長期臥床等慢性基礎疾病以及近期手術、外傷史等。其臨床表現各異,D-二聚體、CT肺動脈造影（CTPA）敏感性高。 結論 ：PTE臨床表現多樣,D-二聚體可作為篩選檢查首選;CTPA可作為無創檢查之首選。確診后正確及時治療可使預后顯著改善。Abstract: Objective: to analyze the clinical character\ methods of diagnosis and therapies of pulmonary thrombus embolism, to improve the precisions of diagnosis and therapy, to make prognosis better. Method : 25 patients of pulmonary thrombus embolism admitted in our hospital in the past seven years, were analyzed by risk factors, clinical manifestation accessory examination and therapies. Result : risk factors of pulmonary thrombus embolism included thrombus in venue profound, senility the diseases of heart and lung, keeping in the bed for a long time, above clinic diseases, operation and trauma in the near future their clinical manifestations were different, the sensitivity of dipolymer and CT pulmonary arteriography were high. Conclusion : clinical manifestations of pulmonary thrombus embolism were various, dipolymer may be regarded as the firster to diagnbose pulmonary thrombus embolism, CT pulmonary arteriography may be regarded as the first non-traumatogenic examination to diagnose pulmonary thrombus emboklism. After the diagnosis, correct therapies in time can greatly improver prognosis.
Abstract: Objective To retrospectively compare the difference of the effects of pulmonary thromboendarterectomy (PTE) between distal and proximal types of chronic thromboembolic pulmonary hypertension (CTEPH). Methods The data of 70 patients (including 44 male patients and 26 female patients, the average age was 46.2 years old, ranging from 17 to 72) with CTEPH having undergone PTE from March 2002 to March 2009 in Anzhen Hospital were retrospectively reviewed. We classified them into two different groups which were the proximal CTEPH group (n=51) and the distal CTEPH group (n=19) according to the pathological classification of the CTEPH. Clinical data, hemodynamics blood gas analysis and so on of both groups were compared. Results There was no perioperative deaths in both groups. Compared with the proximal group, cardiopulmonary bypass time [CM(159mm](189.5±41.5 min vs.155.5±39.5 min,P=0.003), aorta cross clamp time (91.3±27.8 min vs.67.2±27.8 min,P=0.002) and DHCA time (41.7±14.6 min vs.25.7±11.6 min,P=0.000) were significantly longer in the distal group. The incidence of residual pulmonary hypertension in the distal group was significantly higher than that in the proximal group (42.1% vs.13.7%,P=0.013), while the incidence of pulmonary reperfusion injury postoperatively in the proximal group was significantly higher than that in the distal group (41.2% vs.10.5%, P=0.021). SwanGanz catheterization and blood gas index were obviously improved in both groups. However, the pulmonary artery systolic pressure (PASP, 67.8±21.3 mm Hg vs.45.5±17.4 mm Hg,P=0.000) and the pulmonary vascular resistance ［PVR, 52.8±32.1 kPa/(L·s) vs.37.9±20.7 kPa/(L·s),P=0.024］ in the distal group were significantly higher than those in the proximal group and the partial pressure of oxygen in arterial blood of the distal group was significantly lower than that of the proximal group (76.7±8.7 mm Hg vs.88.8±9.3 mm Hg,P=0.000). After operation, 70 patients were followed up with no deaths during the followup period. The time of the followup ranged from 2 to 81 months (32.7±19.6 months) with a cumulative followup of 191.8 patientyears. Three months after operation, 47 patients were examined by pulmonary artery computer tomography angiogram (PACTA) and isotope perfusion/ventilation scan, which showed that the residual occlusive pulmonary artery segment in the proximal group was significantly fewer than that in the distal group (isotope perfusion/ventilation scan: 2.2±11 segments vs. 4.7±2.1 segments, P=0.000; PACTA: 3.5±1.4 segments vs. 4.9±2.0 segments,P=0.009). The New York Heart Association (NYHA) functional class and 6 minute walk distance (6MWD) in the proximal group were significantly better than those in the distal group (1.7±0.5 class vs 2.3±0.4 class; 479.2±51.2 m vs. 438.6±39.5 m, P=0.003). Venous thrombosis in double lower limbs reoccurred in two patients. According to KaplanMeier actuarial curve, the freedom from reembolism at 3 years was 96.7%±2.8%. Bleeding complications occurred in three patients. The linear Bleeding rate related to anticoagulation was 2.47% patientyears. Conclusion Although the early and midlong term survival rate of PTE procedure to treat both proximal and distal types of CTEPH is agreeable, the recovery of the PASP, PVR and 6MWD, and blood gases in patients with proximal type of CTEPH are significantly better than those in patients with distal type of CTEPH. On one hand, anticoagulation can singularly provide enough protection to patients with proximal type of CTEPH, but on the other hand, diuretics and pulmonary hypertension alleviation drug should be added to the treatment regimen for patients with distal type of CTEPH after the procedure of PTE.
ObjectiveTo explore the diagnostic value of the bedside echocardiogram for different risk stratification of patients with suspected pulmonary embolism.
MethodsPatients with suspected pulmonary embolism in the emergency department of the Second Afflicted Hospital Xi'an Jiaotong University between July 2013 to December 2015 were included. According the Wells scores, they were divided into a low risk group (0-2 points), a intermediate risk group (3-6 points) and a high risk group (>6 points). All patients were underwent the bedside echocardiogram diagnosis, and the diagnostic value of the echocardiography for pulmonary embolism, the characteristics of different risk stratification of patients were analyzed by SPSS 18.0 software.
Results115 patients with suspected pulmonary embolism were included, of which 20 were in the low risk group, 73 were in the medium risk group, and 22 were in the high risk group. The incidence of pulmonary embolism among the three groups was significantly different (high-risk vs. medium risk vs. low-risk: 90.9% vs. 76.7% vs. 15.0%, P<0.05), and the higher Wells scores gets, the greater possibility of having the pulmonary embolism. For the intermediate-risk group, the incidence of pulmonary embolism was significantly higher in patients with positive ultrasonic results than those with the negative ultrasonic results (87.3% vs. 44.4%, P<0.05). The predication of the ultrasonic positive and the negative in the low and high risk groups had no statistical differences (P>0.05). The result of echocardiogram showed that the right ventricular end-diastolic diameter, right ventricular end-diastolic transverse diameter, right atrial end-diastolic transverse diameter, RV/LV, RA/LA in the high risk group and the intermediate risk group were significantly higher than those in the low risk group (all P values <0.05). The right ventricular anterior wall activity in the low risk group was higher than that in the high risk group (P<0.05), but this difference was not found between the high risk group and the intermediate risk group.
ConclusionBedside echocardiogram can be used as the diagnosis and differential diagnosis methods of suspected pulmonary embolism, and it has relatively higher diagnostic value for intermediate to high risk patients predicted by the Wells scores than low risk ones.
ObjectivesTo compare the efficacy of acute physiology and chronic health evaluationⅡ (APACHEⅡ), national early warning score (NEWS), pulmonary embolism severity index (PESI) and Charlson comorbidity index (CCI) on pulmonary embolism (PE) prognosis.MethodsClinical data of patients with PE treated in The Second Xiangya Hospital of Central South University from 2010 to 2017 were retrospectively analyzed. They were divided into death group and survival group, and four clinical scores were calculated. The differences of risk factors between the two groups were compared. Logistic regression analysis was used to obtain the independent risk factors related to mortality. The ROC working curve was used to compare the capability of four clinical scores for PE mortality. SPSS 24.0 and Medcalc 18.2.1 software were used for statistical analysis. ResultsA total of 318 patients with PE were included, and the mortality rate was 13.2%. The APACHEⅡ, NEWS, PESI and CCI of the death group were higher than those of the survival group. There were significant differences between two groups (P<0.05). It was confirmed by logistic regression analysis that cerebrovascular disease, heart rate, leukocyte, troponin T, arterial partial pressure of oxygen, right ventricular dysfunction (RVD) were independent risk factors for 90-day mortality. The areas under the ROC curve of APACHEⅡ, CCI, PESI, NEWS were 0.886, 0.728, 0.715 and 0.731, respectively. The area under the ROC curve of APACHEⅡ was the largest, which was better than NEWS, CCI and PESI (P<0.05), and there was no significant difference among NEWS, CCI and PESI.ConclusionsAPACHEⅡ may be the best predictor of mortality in PE patients, which is superior to NEWS, CCI and PESI.
ObjectiveTo investigate the anticoagulant drug treatment decision for patients with renal contusion and acute pulmonary embolism, and to enhance the level of treatment for this disease. MethodsA retrospective analysis of the clinical data of a patient with renal contusion and acute pulmonary embolism treated at the West China Hospital of Sichuan University, along with a relevant literature review. Databases including PubMed, Ovid Medline, Embase, VIP, Wanfang and Chinese National Knowledge infrastructure were searched using the keywords as “Pulmonary embolism” AND “Hemorrhage”from January 1983 to December 2023. ResultThe patient was a 21-year-old male who presented with right kidney contusion for 5 days and dyspnea for 1 day. The abdominal CT scan revealed a ruptured right kidney accompanied by hemorrhage and hematoma in the surrounding tissue. Abdomen ultrasound: a low echogenic area measuring approximately 10.6 cm×2.8 cm is noted around the right kidney. The CT pulmonary angiography (CTPA) demonstrated filling defects at the bifurcation of the pulmonary trunk, as well as within the upper and lower lobes of both lungs and their respective branches. The blood gas analysis of patient indicated (face mask oxygen therapy at 10 L/min, oxygenation index of 120): pH 7.456, PCO2 24.9 mm Hg, PO2 73.2 mm Hg. His myocardial markers were Myoglobin: 79.21 ng/ml, Troponin T: 58.7 ng/L, BNP: 2062 ng/L. The patient was diagnosed with renal contusion and pulmonary embolism, and was treated with subcutaneous heparin（initial dose is given as an 80 IU/kg intravenous bolus, followed by a continuous infusion of 12-18 IU/kg/h） and low-molecular-weight heparin at a dose of 0.8 ml every 12 hours one after another for anticoagulation, along with symptomatic treatment. Following the intervention, the patient's respiratory distress showed significant improvement, and subsequent arterial blood gas analysis indicated enhanced oxygenation. Then, the anticoagulant medication was adjusted to oral rivaroxaban anticoagulation for 6 months, follow-up CTPA scan revealed complete resolution of the pulmonary embolism and the abdominal CT scan indicated a reduction in the extent of patchy low-density shadows surrounding the right kidney, leading to the discontinuation of anticoagulation therapy. After searching the above-mentioned databases, total of 26 articles were identified that reported on 30 patients diagnosed with high-risk bleeding and acute pulmonary embolism; among these, 3 patients succumbed while 27 exhibited clinical improvement. ConclusionsPatients with renal contusion and acute pulmonary embolism can be safely and effectively treated with low-dose heparin anticoagulation under close monitoring. High-risk bleeding patients with acute pulmonary embolism present a significant challenge in clinical practice. After weighing the risks of bleeding disorders and the adverse outcomes of pulmonary embolism, it is necessary to find the optimal balance between anticoagulation and bleeding. Consequently, the formulation of personalized treatment strategies in accordance with established guidelines can enhance patient outcomes.
