既往病史在肺栓塞鉴别诊断中的研究

Study Patient of History in Differential Diagnosis of Pulmonary Embolism

目的:探讨既往病史在肺栓塞和有相似临床表现的几种疾病的鉴别诊断中的应用。方法:共入选295例肺栓塞及对照病例。其中肺栓塞组155例,冠状动脉粥样硬化性心脏病心功能不全组67例,高血压病心功能不全组36例,Ⅰ型呼吸衰竭组37例。对295例病例的年龄、性别、既往病史等临床资料进行回顾性分析。结果:应用多因素非条件Logistic回归进行危险因素分析,静脉血栓史OR值为47．706、P＜0．001,近期外伤手术史(3月内)OR值为30．291、P＜0．001,静脉炎史OR值为25．125、P＜0．01。吸烟在本研究中并没有表现出对肺栓塞的影响。结论:静脉血栓史、近期外伤手术史、静脉炎史是肺栓塞强独立危险因素;高血压可能是肺栓塞的危险因素;吸烟与肺栓塞无明显相关,但Ⅰ型呼吸衰竭与吸烟相关。

Objective： To investigate the usage of the history in differential diagnosis of pulmonary embolism （PE） from several diseases that have likely clinic features.Methods： There were totally 295 cases enrolled into this study, including 155 cases of PE, 67 cases of coronary artery disease （CAD） with congestive heart failure （CHF）, 36 cases of essential hypertension （EH） with CHF, 37 cases of type Ⅰ respiratory failure （RF）. We analyzed past history of 295 cases, Results： We analyze risk factors with Logistic regression. OR of venous thrombeembolism （VIE） history is 47. 701, P 〈 0.001. OR of recently （within 3 month） injury and operation history was 30. 291, P 〈 0.001. OR of phlebitis history is 25. 125, P 〈 0.01. Smoking had no significant difference between PE Patient and control group. Conclusion： The history of VTE, recently （within 3 month） injury, operation and phlebitis were significant independent risky factors, and it was very important for PE diagnosis and differential diagnosis.