急性肺栓塞102例临床分析

Acute pulmonary thromboembolism:clinical analysis of 102 cases

目的分析急性肺栓塞患者临床表现及辅助检查结果,提高临床医生对肺栓塞的诊断意识。方法回顾北京协和医院1999年1月至2002年12月间诊断急性肺栓塞并有较完整临床资料的病例共102例,分析这些患者的临床表现及辅助检查结果,包括血气分析、血常规、心肌酶、D-二聚体、胸片、心电图等变化。结果急性肺栓塞最常见的危险因素依次是下肢深静脉血栓形成(30.4%)、手术后卧床(17.7%)、恶性肿瘤(12.8%);最常见的临床表现依次是气短或呼吸困难(97.1%)、胸闷(87.2%)、心悸(80.4%);最多见的心电图表现依次是窦性心动过速(59.0%)、胸前导联T波倒置(42.6%)、SⅠQⅢTⅢ(20.0%);最常见胸片改变是肺部浸润影(36.8%)、右下肺动脉扩张(29.5%)、肺动脉段突出(17.2%);近1/3患者心电图和胸片无明显异常;90.4%急性肺栓塞患者存在不同程度低氧血症,所有患者都出现肺泡-动脉氧分压差增大;90%急性期患者白细胞总数及粒细胞百分比升高,60%患者血浆心肌酶升高,66%患者血浆D-二聚体阳性。结论急性肺栓塞的临床谱非常广,应注意其诊断及鉴别诊断。

Objective To analyze the clinical manifestations and the auxiliary examinations of patients with pulmonary thromboembolism（PTE） in order to improve the diagnosis of PTE. Methods A total of 102 PTE patients with intact clinical including data including the clinical manifestations and the results of auxiliary examinations such as blood gas, blood routine tests, cardiac enzymes, D-dimmer, chest X-ray and electrocardiogram （ECG） were reviewed. Results The most common risk factors for PTE were deep vein thrombosis（30.4% ）, stay in bed after operation（17.7 %） and malignant tumor（12. 8%）. The most common clinical manifestations were dyspnea（97. 1 %）, chest distress（87. 2%） and palpitation（80. 4%）. The most common ECG manifestations were sinus tachycardia （59.0%）, T wave inversion in precordial leads（42. 6%）,SⅠ QⅢ TⅢ （20. 0%）. The most common presentations of chest X-ray examination were infiltration of lung（36.8%）, dilation of right lower pulmonary artery（29. 5%）, and protrusion of pulmonary artery segment（ 17.2% ）. About 1/3 of the patients had no apparent abnormal ECG and chest X-ray film; 90.4% of the patients had different degrees of hypoxemia; all patients had increased alveoli-artery oxygen pressure gradient. The white blood cells increased in 90% of the patients; the hlood cardiac enzymes were elevated in 60% of the patients; and D-dimmer was positive in 66% of the patients. Conclusion The spectra of clinical manifestations of PTE are very extensive. Attention should be paid to the diagnosis and differential diagnosis of PTE.