52例急性肺栓塞临床分析

Clinical analysis of 52 cases of acute pulmonary embolism

目的探讨急性肺栓塞的早期临床特征、危险因素以及正确的诊断程序。方法对我院2004年1月至2005年12月收治的52例急性肺栓塞患者的发病情况、辅助检查以及易患因素进行评估分析。结果呼吸困难及气促、胸痛、咯血、晕厥等为急性肺栓塞最典型的早期表现，而胸痛、咯血、呼吸困难三者同时出现占11．5％。检测D-二聚体〉500μg/L者为100％，血气分析显示低氧血症占94．2％，心电图呈典型SⅠQⅢTⅢ（Ⅰ导联出现S波、Ⅲ导联出现Q波及T波）占13．6％，超声心动图显示肺动脉高压占82．5％，右心室扩大占38．5％。初诊确诊率为82．7％。下肢深静脉血栓、慢性心、肾疾病、恶性肿瘤以及围手术期患者均是肺栓塞的高危人群。结论急性肺栓塞早期多数无特异性临床表现，对于有高危因素的患者，排除其他原因的呼吸困难、胸痛、咯血等表现后，特别是对有晕厥史者，应及早床旁进行肺栓塞的相关检查，提高初诊确诊率，以防误诊和漏诊。

Objective To explore the early characteristics,risk factors and correct diagnosis procedure of acute pulmonary embolism. Methods The onset, axillary examination and susceptibility of 52 cases of acute pulmonary embolism between Jan 2004 and Dec 2005 were analyzed. Results The early manifestation of acute pulmonary embolism was difficulty in breathing, chest pain, hemota and fatigue. Only 11.5% patients presented all the obove symptomes at the same time. D-dimer 〉 500 μg/L was 100%. Blood gas analysis showed hypoximia in 94.2% ,typical S IQmTm in 13.6% on electrocardiograph,pulmonary artery hypertension in 82.5% on ultrasonography,dilated right in 38.5% of all the subjects. The diagnosis rate was 82.7% at the first diagnosis. Lower limb deep vein embolism, chronic cardiac, kidney disease, malignant tumor and periooperation patients were the risk factors. Conclusion Acute pulmonary embolism is specific-free of clincial manifestation, patients with history of vertigo but excluding difficulty in breathing, chest pain, hemato should go proper examination.