19例肺动脉栓塞诊治的临床分析

Clinical Analysis of the Diagnosis and Treatment of Pulmonary Embolism:A Report of 19 Cases

目的总结肺动脉栓塞诊治过程中的经验和教训,降低漏诊、误诊和病死率.方法回顾分析肺动脉栓塞共19例,治疗前后测得的动脉血氧分压(PaO2)、D-二聚体(DDi)、乳酸脱氢酶(LDH)指标作一自身治疗前后对照资料t检验统计.结果19例经治疗前后PaO2、DDi和LDH经统计学检验有显著差异P均<0.05.结论在高度疑诊时及时行DDi和CTA检查,有助于及早、正确诊断;尽快予以抗凝、溶栓治疗,就能在最大程度上减少肺梗的发生面积,有效改善临床症状和降低致死率.

Objective To reduce the rates of missed diagnosis, misdiagnosis and fatality by summarize the experiences in the diagnosis and treatment of pulmonary embolism （PE）. Methods A retrospective analysis has been performed from 19 clinically confirmed cases, all of whom were given anticoagulation and thrombolytic therapy, and 11 of whom （mainly with lower extremity deep venous thrombosis and malignant pelvis tumors） were implanted inferior vena cava filter （IVF）. Results All patients recovered well after treatment. Two patients （without IVF implantating） recurred PE and returned, after receiving IVF implanting plus anticoagulation and thrombolytic therapy for the second time, both patients recovered without recurrence over an 18-month follow-up. Indications such as PaO2, D-dimer （DDi） , and LDH were compared independently before and after treatment, showing P 〈 0.05 for all. Conclusion Pulmonary embolism will be ultimately detected and diagnosed via carefully observation and auxiliary examinations such as d-dimer test and CTA scanning. Meanwhile, first-time anticoagulation and thrombolytic therapy will dramatically reduce the embolism area of pulmonary with resuhs of symptom improved and mortality descending.