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患者男性,25岁,工人.因右大腿下段肿胀、疼痛并膝关节伸屈功能障碍2年入院.入院时查见大腿下段肿胀,局部皮肤正常,周径较对侧增粗10cm,压痛,膝关节伸屈0°—8°.X线片示右股骨下段囊性溶骨破坏.手术将股骨下段切除,冰冻切片证实为骨巨细胞瘤,行全膝人工关节置换术.在骨水泥填塞后,将假体打入股骨过程中,患者突然咳嗽,呼吸急促达40次/分,口辱紫绀,神志模糊,双肺细小湿啰音,动脉血氧分压7.32kpa.立即暂停手术,给予吸氧,静推氨茶碱0.25g,地塞米松20mg,速尿40mg.胸片见双肺下叶实变,尿检验及痰检验见脂肪颗粒.术中给予尿激酶4400u/kg 静注,然后每小时再给予4400u/kg静注,维持12小时,加用肝素抗凝治疗.患者渐口唇红润,血氧分压升至10.2kpa,尿量多,肺啰音减少并逐渐消失,病人脱险.术后肺功能造影证实为肺栓塞.
The patient was male, 25 years old and was suffering from swelling and pain in the lower right thigh and knee flexion and extension dysfunction for 2 years .It was found that the lower thigh was swollen at the time of admission, the local skin was normal, and the circumference was 10 cm thicker than the contralateral side. Joint flexion 0 ° -8 ° .X ray showed the right femoral cystic osteolytic destruction of the femur surgery under the lower resection, frozen section confirmed giant cell tumor of the knee, knee arthroplasty arthroplasty in the bone cement packing, The prosthesis into the femur process, the patient suddenly cough, shortness of breath as rapid as 40 beats / min, insanity cyanosis, confusion, small lung wet rales, arterial partial pressure of oxygen 7.32kpa. Immediate suspension of surgery to give oxygen , Intravenous push aminophylline 0.25g, dexamethasone 20mg, furosemide 40mg. See the lungs under the lung solidification, urine test and sputum see fat particles. Intraoperative administration of urokinase 4400u / kg intravenous, and then each Hours and then given intravenous 4400u / kg, maintained for 12 hours, plus heparin anticoagulant therapy. Patients with lip rosy liposuction, partial pressure of oxygen rose to 10.2kpa, more urine, pulmonary rales reduced and gradually disappear, the patient out of danger. Post-pulmonary angiography confirmed pulmonary embolism.