PULMONARY THROMBOEMBOLISM IN CANCER PATIENTSAFTER SURGERY
Belarusian State Medical UniversityPULMONARYTHROMBOEMBOLISM INCANCER PATIENTSAFTER SURGERYBakulina L.A.,516 group, general medicinefacultyChief: M.D. Shepet`ko M.N.Minsk 2013
PE – thrombotic occlusion of the main trunk of thepulmonary artery or its branches of various calibers.PE is one of the mostformidable postopcomplication. It ishardly diagnosedbecause of nospecificmanifestations,leading to highmortality.
The goal and objectives of thestudyThe Goal: To identify the most significant cause of blood clotsin the pulmonary artery in cancer patients after surgeryThe Objectives:1. Retrospectively assess the group of patients, dependingon:o diagnosiso Body Mass Index (BMI)o TNM classificationo probability of pulmonary embolismo type of performed surgerieso prescription of anticoagulanto postoperative ECG changes2. Evaluate the results
Materials and methodsThe work is based on the retrospective analysis of thecase histories of the patients who were treated at theMinsk city clinical oncocenter from 2008 to 2012.Over this period 53 patients died of PE
The age structure of patientsAverage age 67,4±1,4
ИМТBMIBody massindexThe correlatiopne between the weight of the person and hisgrowth16 and less Expressed mass deficiency16—18,5 The lack (deficiency) of body weight18,5—25 Normal weight25—30 Overweight (pre-obese)30—35 first degree obesity35—40 second degree obesity40 and more third degree obesity
The distribution of patientsaccording to the TNM classification
Preliminary assessment of theprobability of PE
The results11 (20,7%) patients died suddenly in the hospital.42 (79,3%) patients were operated on.Postoperative complications were observed in 13 (24.5%) patients.The duration of the procedure0,00%10,00%20,00%30,00%40,00%50,00%0-59 60-119 120-179 180-239 240-319 320-379 380-439
Indicators ofcoagulationThere is an inverse correlation between PTT,PTI and the number of past days
Anticoagulation therapyThe maximum life span:With the appointment of an anticoagulant - 45 daysWithout an appointment - 41 days
ElectrocardiographySpecific changesfor PE:-EOS-deviation to the right-high-peaked P wave in II,III standard leads-ST elevation up to III,avR, V1-V2-high-R wave in avR- TIII, avF, V1-2 anddeprtession in I, II, avLand V5-6displacement of thetransition zone to V4-V5-RBBB, LBBBRBBB & LBBB wererevealed in 12(22,6%) patients
Evaluation of hypoxiaSp O2 during the surgery: 97±0,5 %
Conclusions:1. Most of the patients who died of PE suffered fromtumor process in an advanced stage (M1, T4, T3).2. Hypercoagulation is a significant risk factor thatprovokes the development of PE.3. One of the main factors in the development of PE is apostoperative hypoxia and hypercapnia.4. The ongoing anticoagulation therapy is reasonable,but does not always lead to the desired effect - asignificant reduction in thromboemboliccomplications, an increase of the life expectancy.5. The risk of PE was higher in the group of patientswith a BMI> 25, and the duration of surgery> 120minutes.