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Prognostic factors for pulmonary thromboembolism

作者:ZHANG Yun-jian et al.   发布时间:2013-03-14 18:13:31   浏览次数:1943

 Prognostic factors for patients with pulmonary thromboembolism after orthopaedic surgery

ZHANG Yun-jian1 ,ZHAO Ning2, XIA Guo-guang1 LI Tianshui1 WANG Yan-xia1

(1Department of RespiratoryJishuitan HospitalBeijing 100035China2Department of Internal MedicineAir Force General HospitalPeople’s Liberation Army)

ABSTRACT ObjectiveTo investigate the changes of serum enzymes and their prognostic value in patients with pulmonary thromboembolism after orthopedic surgeryMethodsClinical data of 1 34 cases of confirmed pulmonary thromboembolism after orthopedic surgery from 1997 to 2010 were reviewedThe 134 cases were divided into dead group( n=28)and survival group(n=106)The clinical presentationelectrocardiogramarterial oxygen pressure(PaO2)chest X-ray, echocardiographyand serum enzymes including alanine transaminase(ALT)aspartate aminotransferase(AST)gamma-glutamyl transpeptidase( gamaGT)lactate dehydrogenase(LDH)creatine kinase(CK)and creatine kinase isoenzyme(CKMB)were analyzedAnd multivariable Logistic regression was conducted to identify the risk factors of inhospital deathResultsThe average age of dead patients was higher than that of survival patients(P=0043)while the P(O2)of dead patients was much lower than that of survival patients(P=0035)The percentage of syncopehypotensionright bundle-branch block and S I QTⅢ,pulmonary hypertension and right ventricular dysfunction in dead patients were higher than those in survival patients(P=0009P0041P=0018P=0030P=0042 and P=0038)respectivelyThere were significant differences of elevated serum ALTLDH and CKMB levels between dead patients and survival patients(P=0042P=0035 and P=0017)Logistic regression indicated that the risk factors for death of patients with PTE after orthopedic surgery were age(OR118295 CI10101383P=0036)hypoxemia(OR112895CI10181249P=0022)hypotension(OR334695 111610031P=0031), right ventricular dysfunction(OR408395 CI104016035; P=0044)and elevated serum CKMB levels(OR346695CI105411400P= 0041)ConclusionThe incidence rate of elevated serum ALTLDH and CKMB levels in patients who died of pulmonary thromboembolism after orthopedic surgery was higher than that of survival patientsAgehypoxemiahypotension and right ventricular dysfunction were independent risk factors of inhospital deathThe CKMB might be a useful biomarker for risk stratification of acute PTE

KEY WORDS Pulmonary embolismBone and bonesPostoperative periodEnzymesPrognosis







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