36例肺血栓栓塞症的临床特点及预后分析

Clinical characteristics and prognosis Analysis of pulmonary thromboembolism in 36 cases

目的探讨肺血栓栓塞症(PTE)的临床特点及预后相关因素。方法回顾性分析总结我院近十年来确诊的36例PTE患者的临床资料,所有患者经核素肺通气/灌注扫描或螺旋CT肺动脉造影或磁共振肺动脉造影确诊。结果本组误漏诊率52.8%,总死亡率33.3%。大多数患者具有PTE的危险因素,以下肢深静脉血栓、心肺慢性疾病、长期卧床多见;临床表现不典型,最常见症状为呼吸困难,其次为胸痛、咯血、心悸,缺乏特异性体征;多数患者实验室检查血浆D-二聚体增高(>0.5 mg/L),血气分析显示低碳酸血症、肺泡—动脉血氧分压差增大。肌钙蛋白I阳性组和超声心动图结果右心功能不全组的休克发生率及死亡率均高于肌钙蛋白I阴性组和右心功能正常组,其差异具有显著性(P<0.05)。结论PTE缺乏特异性临床表现,误诊率高,临床上要加强对该病的诊断意识,疑诊病例及时采取相关检查确诊;肌钙蛋白I阳性、超声心动图结果右心功能不全提示预后不良。

Objective To explore the clinical characteristics and the relative factors of the prognosis of pulmonary thromboembolism （PIE）. Methods We retrospectively analyzed the clinical material of 36 patients with PIE, who were diagnosed by ventilation perfusion scan or CT pulmonary angiography or MR pulmonary angiography in our hospital in the last ten years.Results The misdiagnosis and missed diagnosis rate of this group was 52.8%. The mortality rate was 33.3%. Most of the patients with PTE had risk factors. The familiar factors were deep venous thrombosis of lower limbs, chronic pulmonary or heart diseases and long - term staying in bed. Most of the patients were lack of typical symptoms and special signs, The most common symptoms included dyspnea, chest pain, emptysis and palpitation. Most laboratory findings showed that D- dimer increased（ 〉 0.5 mg/L）. Blood gas indicated the levels of arterial PaCO2 decreased and PA-aO2 increased. Groups with positive troponin I tests or right ventricular dysfunction of echocardiogram result had significantly higher incidence of shock and mortality than the normal group（ P 〈0.05）. Conclusion Patients with PTE are lack of special clinical symptoms. The misdiagnosis rate of PIE is high. Doctors should pay more attention to this disease so as to raise the rate of accurate diagnosis. Positive troponin I test and right ventricular dysfunction of echocardiogram result indicate severe prognosis.