急性肺血栓栓塞症患者516例临床表现分析

The clinical features of 516 patients with acute puhnonary thromboembolism

目的评价急性肺血栓栓塞症(PTE)患者的症状和体征,总结治疗后临床表现的改善情况。方法采用前瞻性描述性研究方法,将明确诊断为PTE的516例患者分为大面积、次大面积PTE组(246例)和非大面积(不含次大面积)PTE组(270例)。大面积、次大面积PTE组随机使用尿激酶或重组组织型纤溶酶原激活剂(rt-PA)进行溶栓治疗,非大面积PTE组随机使用普通肝素或低分子肝素抗凝治疗,在治疗前和治疗后14 d的不同时间段内观察患者呼吸困难、胸痛(包括胸膜炎性胸痛和心绞痛样胸痛)、咳嗽、咯血、晕厥等症状,及肺部和心脏体征,计算不同时间段各种临床表现的发生率。结果急性PTE患者最常见的症状为呼吸困难(88．6％),其次为胸痛(59．9％)和咳嗽(56．2％),仅有26．0％的患者出现咯血。大面积、次大面积PTE组呼吸困难、心悸、晕厥、惊恐、濒死感的发生率明显高于非大面积PTE组(P<0．01),而非大面积PTE组胸膜炎性胸痛的发生率明显高于大面积、次大面积PTE组(P<0．01)。大面积、次大面积PTE患者呼吸困难以中重度为主,非大面积PTE患者的呼吸困难程度较轻。急性PTE常见的体征为呼吸频率增快(51．7％)。大面积、次大面积PTE组中有22．8％出现晕厥,21．5％出现体循环低血压或休克,发绀(45．9％)和P2亢进(63．0％)较为常见。溶栓和抗凝治疗后患者的症状和体征随治疗时间的延长而逐渐改善。结论呼吸困难是急性PTE患者最常见的症状,其程度随FIE面积的增大而加重。呼吸频率增快是PTE最常见的体征。溶栓和抗凝治疗均可显著地改善患者的临床症状和体征。

Objective To evaluate the clinical signs and symptomes of acute pulmonary thromboembolism （PTE） and the improvement after thrombolytic and anticoagnlant therapy. Methods 516 patients with a first episode of PTE were included in the muhicenter randomized study with prospective data collection： 246 with massive and sub-massive PTE and 270 with non-massive PTE. Thrombolytic agents （nrokinase or rt-PA randomized） were used for massive and sub-massive PTE and anticoagnlant agents （Ⅳ infusion of unfractioned heparin or subcutaneous of low-molecular-weight heparin randomized ） were administered for non-massive PTE. All patients were submitted to symptoms （such as dyspnea, chest pain, cough, heamoptysis, syncope, etc） and signs （including lung and heart signs） surveillance before treatment and 14 days after treatment were calculated. The percentages of clinical features on the day of before treatment, and 1, 4, 7, 10 and 14 days after treatment. Results Dyspnea （88. 6% ）, chest pain （59. 9%, include anginatic pa-n and pleufitic pain） and cough （56.2%） were the most frequent initial symptoms. Hemoptysis presented in only 26.0% of all patients. Increase of respiratory rate was the most frequent signs （51.7%）. Syncope and low body pressure （or shock） were seen in 22. 8 % and 21.5% of the patients with massive and sub-massive PTE respectively. Cyanosis （45.9%） and increased S2P （63.0%） were the most common signs in this group. All symptoms and signs cleared progressively from the pre-treatment evaluation to the 14 day follow-up examination. Conclusion Dyspnea is the most common symptom of acute PTE, and is aggravated with the degree of PTE. Tachypnea is the most common sign. Thrombolytic and anticoagulant therapy can improve the clinical features of acute PTE markedly.