不同手术方式对脊柱手术后肺栓塞发生的影响

摘要

Objective To make comparison of occurrence and risk factors of postoperative pulmonary embolism (PE) between spinal surgeries of combined anterior/posterior approach and posterior approach. Methods A retrospective analysis was made in the clinical data of patients receiving spinal surgeries of combined anterior/posterior approach and posterior approach from 2007 to 2011. Comparison was made in the patients' general status, operative time, blood loss, blood transfusion volume, fused segment, and the occurrenceof PE verified by CT examination. Results Totally 82 patients were included in the statistical analysis. Among them, 43 patients underwent the spinal surgery of simple posterior approach, in which PE occurred in one case (2. 3% ) ; 39 patients underwent combined anterior/posterior approach surgery, among which PE occurred in 4 cases ( 10. 2% ). The occurrence of PE in patients receivingthe combined approach surgery was 4 times of that in patients receiving the simple posterior approach surgery (OR =4. 12) , but the difference was not statistically significant (P>0.05). Compared with the patients receiving the simple posterior approach surgery,rnthose receiving the combined approach surgery were older and had high BMI, more fused segments, and more blood loss and blood transfusion volume (P < 0.05 ). Conclusion Patients undergoing combined approach surgery has higher risk of PE than those receiving the posterior approach. However, besides the surgical approach, the operative time, blood loss, and fused segment are also the risk factors for the occurrence of PE. Prolonged operative time and severe blood loss are high risk factors for the occurrence of PE after spinal surgery.%目的 比较前/后联合入路和后入路脊柱手术后肺栓塞(PE)发生情况及危险因素.方法 回顾分析2007～2011年进行前/后联合入路和后入路脊柱手术的患者资料,比较两种手术方式患者一般情况、手术时间、失血量、输血量、融合节段以及CT证实的PE发生情况.结果 82例患者进入统计分析:其中43例行单纯后入路脊柱手术,1例患者发生PE(2.3％)；39例患者行前/后联合入路脊柱手术,4例患者发生PE(10.2％).联合入路手术患者发生PE的风险为单纯后入路手术患者的4倍(OR =4.12),但是没有统计学差异(P＞0.05).比起单纯后入路手术患者,联合入路手术患者年纪大、BMI高、融和节段多、失血量及输血量多(P＜0.05).结论 联合入路患者比后入路手术患者发生PE的风险更高.但是,除了手术入路方式外,手术时间长、失血量大、融合节段数多也是PE发生的危险因素.手术时间长和大失血是脊柱手术发生PE的高危因素.