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目的：探讨影响术后急性肺栓塞（Acute Pulmonary Embolism，APE）的发生和预后的相关因素，以提高对术后肺栓塞的认识和诊疗水平。方法：收集2009.01-2014.12 期间南方医院术后疑似急性肺栓塞患者的临床资料，总结其临床特征，分析其诱发因素、临床表现、治疗和预后，探讨其发病的高危因素。结果：共收集术后疑似肺栓塞43 例，平均年龄56.09± 14.08 岁(17~80 岁)，明确诊断为肺栓塞15 例（34.9%），共死亡20例（死亡率46.5%）。其临床表现和体征均具有非特异性，呼吸困难、心悸和晕厥是主要的临床表现。不仅可以发生于下肢、胸腹部（包括妇产科）、颅内等大手术后，也可能发生在介入栓塞术后。相关危险因素很多，包括性别、年龄、恶性肿瘤、全身麻醉、手术时间长等。具有高危因素的患者并具有可疑肺栓塞的临床表现时，结合D-二聚体、动脉血气分析、心电图、胸部X 线、超声心动图、下肢彩超可检查协助APE 的诊断，而胸部增强CT 作为检查手段有利于明确诊断。结论：肺栓塞是手术后致命的并发症之一，早期诊断、早期治疗，能降低术后肺栓塞患者的死亡率。

英文摘要:

Objective:To evaluate the prognosis and risk factors of patients with postoperative pulmonary embolism.Methods:Retrospective investigation was carried out in postoperative patients with suspected pulmonary embolism in our hospital between Jan 2009 and Dec 2014. The clinical date, diagnosis and treatment, prognosis and risk factors of suspected postoperative pulmonary embolism were analyzed.Results:43 patients with suspected pulmonary embolism, 17 to 80 years old (Mean 56.09± 14.08yr), were collected. 15 casess (34.9%) were diagnosed as acute pulmonary embolism, and 20 cases (46.5%) died. Dyspnea, palpitation and fainting were the main clinical manifestations and were nonspecific. Pulmonary embolism could occurred in postoperative patients underwent lower extremity, thoracic, abdominal, gynecological and intracranial surgery, also after interventional therapy. Gender, age, cancer, general anesthesia and long operating time were significant risk factors of pulmonary embolism. The D-dimmer test, arterial blood gas analysis, electrocardiogram, chest radiography, echocardiogram and vascular ultrasonography of lower extremity were beneficial to these patients with the high-risk factors and the clinical manifestations of suspected pulmonary embolism, chest CT enhancement scan was helpful to clarify diagnosis for pulmonary embolismearly.Conclusion:Pulmonary embolismis a potentially life-threatening complication after major surgical procedures. Early diagnosis and treatment is essential to reduce the mortality of postoperative pulmonary embolism.

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