37例肺栓塞的临床诊断与治疗

Clinical Analysis of 37 Patients With Pulmonary Embolism

目的对肺栓塞进行临床分析,评价肺栓塞的诊断程序及治疗效果。方法对2003年1月-2007年3月入院并确诊的37例栓塞的临床表现、检查、诊断及治疗方法进行临床分析。结果37例肺栓塞患者中,首次误诊率为64.86%,D-二聚体大于500 mg/L者占94.59%,超声心动图呈典型改变者占86.48%,血气分析异常者占91.89%,增强螺旋CT和肺动脉造影敏感性为97.29%和100%。接受溶栓治疗的18例患者中无死亡,接受抗凝治疗19例患者中死亡1例。结论肺栓塞的发病与易患因素密切相关,肺栓塞的临床症状体征不典型,需结合辅助检查进行诊断。溶栓治疗可提高患者生存率。肺栓塞的误诊率高,提高诊断意识和诊断水平是临床医生的当务之急。

Objective To analyse pulmonary embolism and to evaluate diagnostic procedure and therapeutic efficacy for patients with pulmonary embolism. Methods The predisposing factors, clinical assessmenst, diagnosis and treatment of 37 consecutive patients with established pulmonary embolim were analyzed retrospectively. Results Total mistake diagnosis rate of first consultation in 37 PE was 64.86%, in all 37 patients with PE, 91.89% of them has hypoxaemia and/or hypocapnemia, 94.59 % D- dimer 〉 500 mg/L, 86.48 % have tipical findings on ultrasonic cardiogram （UCG）, 100% have positive outcome on lung scanning. The sensitivity of CT and pulmonary angiography were 97.27% and 100%. 18 patients received thrombolytic therapy, none died. The other 19 patients received anticoagulant therapy, one died. Conclusions The incidence of pulmonary embolism is closely related to the associated factors. Clinical symptoms and signs of pulmonary embolism were atypical. The role of clinical assessment was important. Thrombolytic treatment can im prove the survival rate of patients with pulmonary embolism. Mistake diagnosis rate of PE is high, to improve diagnosis consciousness and diagnosis level is the urgent.