肺栓塞的临床研究

Study of the clinical character of pulmonary embolism

目的探讨肺栓塞的临床特征,减少肺栓塞的早期误诊.方法经病史采集,常规体格检查,胸部X线片、血气分析、心电图、超声心动图,最后经增强CT、肺动脉造影确定诊断.结果19例患者中男14例,女5例,年龄25～73岁,平均年龄52岁.病程1个月～3个月.栓子来源有下肢深静脉血栓6例(占31.5%),胫骨骨折4例(占21%).临床表现有活动性呼吸困难12例,心悸、胸痛4例,气短、小量咯血3例;体征有心率＞100次/min 16例,心尖部及三尖瓣区收缩性杂音4例,P2亢进10例,肺部罗音8例;辅助检查可见X线显示肺动脉凸出11例,右室大11例,肺部密度增高阴影8例.心电图表现S1QⅢTⅢ,仅4例,右室大9例,TV1～V4倒置3例;超声心动图右室大14例,右房大10例,肺动脉高压10例,心包积液1例.血气分析低氧血症14例,低碳酸血症13例.本组病例中有13例(68.4%)曾被误诊.结论肺栓塞有活动性呼吸困难、心悸、咯血;X线显示肺动脉凸出,超声心动图右室大,肺动脉高压应想到本病.增强CT、肺动脉造影是确诊本病的重要手段.注意肺栓塞的危险因素,对疑有肺栓塞的患者应及时进行有关检查是减少肺栓塞早期误诊的重要措施.

Objective To study the clinical character of pulmonary embolism and decrease the rate of misdiagnosis of early pulmonary embolism. Methods Made a diagnosis through collection of patients' history, making a chest, analyzing the patients blood , making a cardiogram and ultrasonic cardiogram for patients and finally through an enhanced CT scan and making a pulmonary artery image of patients. Results Of the 19 patients, 14 males and 5 females . Their age was between 25-73years old . And their average age was 52. Course of disease was 1-3months. Embolism came from the leg vein thrombus, 6 patients(31.5%). Shinbone broken ,4 patients(21%). Of the clinical symptom, twelve patients had an active breath difficulty, four patients had heart-throb and angina, three patients had pant and emptysis, sixteen patients had a body symptom of heart beating rate >100 times /min, four patients had a heart tip and tricuspid valve contractibility noise, ten patients had a P2 sthenic, eight patients had a heart noise, eleven patients could be seen lung artery protrusion through an X-ray examination, eleven patients' right ventricles were enlarged, eight patients' lung shadow augmented four patients had a SⅠ QⅢTⅢ cardiogram showed and nine patients' right ventricles were enlarged, three patients' T V1~V4 were upside-down, fourteen patients' ultrasonic cardiogram showed their right ventricles enlarged, ten patients' right atria were enlarged, ten had a high lung artery pressure, one patient has hydropericardium, fourteen patients had low oxygen blood symptom and thirteen patients had low carbonic aced blood symptom. In this group, thirteen patients (68.4%) were misdiagnosed. Conclusion Pulmonary embolism patients have active breath difficulties, pant and emptysis, lung artery protrusion, right ventricle enlarged and high artery pressure. CT scan and pulmonary artery image of patients is an important means to diagnose. In order to decrease misdiagnosis, more attention should be paid to the dangerous facts of pulmonary embolism and an timely examination should be made to the suspected patients.