以晕厥为首发症状的肺栓塞30例临床分析

Treatment of pulmonary embolism with syncope as first symptom:analysis of 30 cases

目的探讨以晕厥为首发症状的肺栓塞临床特点及治疗。方法对以晕厥为首发症状的30例肺栓塞患者(30～50岁),先给予低分子肝素或肝素抗凝治疗,低分子肝素5000U每日两次皮下注射,后行50万U尿激酶静脉注射溶栓治疗。结果经抗凝,并行尿激酶溶栓治疗后,死亡4例,占13.33%;好转12例,占40.0%;治愈13例,占43.33%;无变化者1例,占3.33%。治愈及好转患者下肢肿胀、压痛及劳力性呼吸困难逐渐消失,恢复正常活动。结论抗凝和尿激酶溶栓治疗对以晕厥为首发症状的肺栓塞有效。

Object i ve To explore the clinical features and treatment of pulmonary embolism with syncope as the first symptom. Methods Thirty patients of pulmonary embolism with syncope as the first symptom, aged 30～50, underwent anticoagulation therapy with subcutaneous injection of heparin or low molecular weight heparin 5000 U for 2 weeks and thrombolytic therapy with intravenous injection of urokinase 500 000 U and then underwent oral administration of the anticoagulant warfarin for 3N6 months to control the activated partial thromboplastin time to the level as 1.5N2.5 times that of normal value. The curative effect was evaluated. Results After urokinase antieoagulation therapy, 4 patients died with a mortality of 13.33%; the condition was improved inl2 cases （40.0%）, and was unchanged in 1 patient （3.33%）; and cure occurred in 13 patients （43.33%）. The symptoms of lower extremity swelling, tenderness, and exertional dyspnea gradually disappeared in the patients who were cured or showed improvement and they resumed normal activities at last. Conclusion Treatment of antieoagulation combined with thrombolytic therapy is effective in treatment of pulmonary embolism with syncope as the first symptom.