急性肺栓塞21例临床诊治体会

Clinical Characteristics and Treatment of 21 Patients with Acute Pulmaonary Embolism

目的:分析急性肺栓塞的临床特点,观察溶栓、抗凝治疗对急性肺栓塞的临床治疗效果。方法:21例肺栓塞患者根据临床症状、体格检查、实验室检查、超声检查及肺动脉造影确诊。21例患者均行肺动脉造影确诊,对其中不属溶栓适应症的8例给予肝素抗凝治疗,属溶栓适应症的9例行静脉溶栓加抗凝治疗,对其中血液动力学差的中/大块肺栓塞4例行肺动脉内导管碎栓、吸栓加肺动脉内尿激酶溶栓再加术后抗凝治疗。以临床、化验室检查及超声心动图及肺动脉造影评价治疗效果。结果:院外误诊率高达77.8%,尿激酶溶栓加抗凝治疗组13例,总有效率为63.2%。根据本组有限病例观察溶栓效果与栓塞面积未见差异,而与发病开始到溶栓治疗的时间密切相关(P<0.05)。肝素抗凝8例,1例无效。结论:应提高肺动脉栓塞的警惕性,减少误诊率。尿激酶对急性大块肺栓塞溶栓抗凝治疗安全有效,溶栓时间窗越靠前疗效越好;对有溶栓适应症的患者应首选溶栓治疗。

Objective： To evaluate the efficacy of thromblytic therapy with urokinase （ UK ） and antico- agulation therapy with heparin, and analyze the clinical characteristics of pulmonary embolism . Methods： The diagnosis of pulmonary embolism was based on the results of perfusion lung scanning , selective pulmonary arteriography or ultrasound cardiogram. Thirteen patients wrer treated by thrombolytic therapy, and eight by anticoagulant therapy. Results： Misdiagnostic rate before hospital admission was 77.8%. Thirteen patients with pulmonary embolism were treated by UK. The effective rate was 63.2%. The area of embolism was not related to the effectiveness of thrombolytic therapy, but the time starting the therapy was closely related to efficacy （ P = 0.03 ）. eight patients were treated by heparin , of who hepatin was effective in one. Conclusion： It is effective and safe to administer UK intravenously in patients with acute pulmonary embolism. Thromboiytic therapy is the first choice, the earlier the better.