척추손상환자의 폐색전증에 관한 전향적 분석

Background: Among various complications during the management of patients with multiple injurles, pulmonary embolism (PE) is known to be rare, but catastrophic, despite aggressive treatment. We present a case control study comparing the occurrence of PE in patients with spinal injury who underwent surgery with that of patient in a control group to determine its incidence and to suggest guidelines for treating this lethal complication. Methods: A prospective analysis of a total of 98 patients (27 spinal-injury and 71 control-group patients) was done during the last 3.5 years. The control group consisted of 71 patients who had undergone spinal surgery due to non-traumatic etiology (degenerative disc disease, 51; infection, 8; instability, 7; and tumor, 5). To detect the PE, we carried out a perfusion/ventilation lung scan preoperatively and one week postoperatively. The incidence of PE and its outcome after treatment were analyzed. A statistical analysis was performed. Results: The incidence of PE in patients with spinal injury was 18.5% (5/27 patients); that of the control group was 1.4% (1/71 patients) (p < 0.05). The PE was detected in 2 patients preoperatively and in 4 patients postoperatively. Among these 6 patients, three were symptomatic. All the patients with PE showed marked improvement clinically and on follow-up perfusion/ventilation lung scan after high-dose heparin therapy for 7-10 days. Conclusions: The results of the present study indicate that PEs develop so frequently in patients with spinal injury that early detection may be possible using a perfusion/ventilation lung scan. Also high-dose heparin therapy was an effective treatment for a PE.