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手術 및 麻醉後 發生하는 肺血栓性栓塞症에 關하여

PULMONARY THROMBOEMBOLISM FOLLOWING OPERATION AND ANESTHESIA

대한의학협회지 1969년 12권 5호 p.520 ~ 530
이규선,
소속 상세정보
이규선 (  ) - General Hospital Singapore Anaesthetic Unit

Abstract


A series of 15 atopsy-proven cases of postoperative pulmonary thromboembolism between the years. 1952-1968 is presented. These cases were obtained from a retrospective review of the post-mortem records from the Pathology Dept., Singapore General Hospital.
As the records before 1962 are incomplete it is. only possible to give the exact figures for fatal postoperatve pulmonary thromboembolism between the years 1962-1968 inclusive. This works out to one in 12,805 cases.
Postoperative pulmonary thromboembolism is a very rare condition in Singapore and Malaysia in with west countries.
In Singapore it occurs more frequently in people above 50 years of age. There is no sex or racial, predilection.
Bilateral pulmonary arterial embolisation was the most frequent finding. In cases of massive pulmonary thrombus sudden deaths following an acute attacks of dyspnea was the clinincal presentation. The commonest source of the thrombi was from the veins of the lower extremity, followed by the pelvic veins. There was no difference between the source on the right and left sides of the body.
Predisposing factors appeared to be chrondically debilitated patients, prolonged bed rest, fractures of the hip and femur, severe anemia, congestive cardiac failure, dry gangrene, pulmonary emphysema, previous cardiac infarction, and prostate hypertrophy.
In all the cases embolism occured 2 weeks following operation and death followed within 24 hours of the onset of symptoms.
Most of the cases occured in patients undergoing abdominal surgery and in those who were given general anesthesia.
Pulmonary embolisation in surgical patients appears more often as a single massive episode and less often with preliminary nonfatal episodes than in medical patients. Pulmonary embolism was. unsus pected in 13 of the 15 patients who died following operation. The clinical pictures, in many instances, were caused by the primary disease. The symptoms are usually abrupt in onset but vary from complete absence to the pattern of the characteristic clinical pictures of the pulmonary embolism. About the commonest finding in this series is a dyspnea and tachycardia.
Severe bonchospasm occurring during or after anesthesia is a significant early sign of pulmonary embolism and this was noted in 2 cases in this series.

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