Clinical Study Of Surgical Treatment Of Pulmonary Embolism

Objective To investigate the risk factors for pulmonary embolism,major imaging diagnostic methods and biochemical test methods,surgical methods for surgical treatment of chronic pulmonary embolism,indications for surgery,short-term and mid-term and long-term outcomes,and analyze perioperative mortality and death of pulmonary embolism.Causes,various complications occurring in the near future and in the mid and long term and their related treatment methods,summarizing clinical experience and lessons learned,and helping patients with pulmonary embolism to choose reasonable and effective treatment methods.Methods This project uses the statistical methods used in analysis,the First Affiliated Hospital of Zhengzhou University,the advantages of clinical case management,on January 2008 to January 2018 underwent surgical treatment in cardiovascular surgery the First Affiliated Hospital of Zhengzhou University,52 cases of chronic pulmonary embolism patients as object for clinical research of patients(1)General information: the constituent ratio of male and female,average the average body weight,age,duration of illness;(2)Clinical manifestations: the main clinical symptoms and signs,such as difficulty breathing,chest pain,hemoptysis and other typical triad and other subjective symptoms and signs;(3)Check method and biochemical test methods and results of main imaging: such as pulmonary angiography or more than 64 layers of CTA pulmonary perfusion imaging,magnetic resonance angiography and magnetic resonance imaging and chest X film,super Doppler heart Echocardiography,lower extremity deep venous color Doppler ultrasound examination,chest CT scan,radionuclide pulmonary ventilation /(V/Q)imaging,electrocardiogram and blood routine,urine routine,electrolytes,blood coagulation function,liver function,plasma D-two dimer,ABO blood group;(4)Pulmonary embolism in patients with surgical indications,surgery the method and process and after corresponding treatment,perioperative monitoring index(Pa O2,Sa O2,cardiac output and pulmonary artery systolic pressure)(5)The corresponding treatment during surgery perioperative mortality,causes of death and related complications;(6)The corresponding follow-up of lung patients with arterial embolization and long-term complications and causes of death.The measurement data using X±S said,compared with the measurement data before and after the surgery of the same patient test for paired data,calculated and analyzed by using SPSS24.0 statistical software,P<0.05 said the difference was statistically significant.Results 1.Pulmonary artery embolism in patients with perioperative deaths is 8 cases,the probability of death is about 15.3%;3 patients died of postoperative pulmonary hypertension,2 cases died of lung reperfusion injury caused by respiratory failure,2 patients died of postoperative heart failure,1 patients died of renal failure after the operation.The survival of patients with postoperative follow-up heart Doppler echocardiography,14 patients with residual pulmonary hypertension in patients with postoperative pulmonary artery systolic pressure were significantly improved compared with preoperative,hemodynamic indexes were significantly improved,cough,chest tightness,chest pain and other clinical symptoms were significantly reduced in patients with more than 64 layers;review of pulmonary artery perfusion CTA imaging display of pulmonary embolism obstruction was relieved or disappeared.There were significant differences in hemodynamics and vital signs before and after the operation(P < 0.05).2.After the follow-up,44 patients were followed up for a total of 1-120 months (53.5±40.7 months),with a total of 158.4 years of follow-up.Subjective symptoms and signs improved significantly in 27 cases,symptoms and signs slightly improved in 8 cases,3 patients also had obvious dyspnea(NYHA heart function classification: I-II level 27 cases,III level patients 8 cases,IV grade 3 patients).6 patients died after operation.1 patients died of liver failure second years after operation.2 patients died of pulmonary artery reembolization within second and fourth years after operation.3 patients died of heart failure in 3 years,8 years and 10 years after operation.The main cause of clinical symptoms and death is hemodynamic changes induced pulmonary hypertension and pulmonary artery reembolization,as well as other organ and systemic failure caused by heart failure.Conclusion 1.The mortality of pulmonary embolism is high,only third after malignant tumor and coronary heart disease.2.There are many kinds of pulmonary embolism,including thrombosis,fat embolism,air embolism,tumor cell embolism and amniotic fluid embolism.Thrombosis is the main cause,accounting for 85%.3.The clinical symptoms of patients with pulmonary embolism are lack of specificity,mainly for exertional dyspnea,such as chest pain,syncope,hemoptysis,cough,palpitation,fever,and obvious symptoms of triad,which is "dyspnea,chest pain and hemoptysis" at the same time.4.Pulmonary arteriography,more than 64 layers of pulmonary artery CTA perfusion imaging,magnetic resonance pulmonary angiography and magnetic resonance imaging are all the "gold standards" for diagnosis and treatment of pulmonary embolism.5.Although the success rate of pulmonary artery embolization(PTE)is very high,postoperative pulmonary artery can not completely return to normal hemodynamics,and there will be complications after operation.6.Due to the limited clinical data of this study center,it has certain limitations.The short-term and mid-to-long term efficacy of surgical treatment of chronic pulmonary embolism remains to be further studied.