急性肺血栓栓塞症患者远期预后及其影响因素分析

Long-term outcome and its prognostic factors in patients with acute pulmonary thromboembolism

目的探讨急性肺血栓栓塞症(PTE)患者的远期预后及其影响因素。方法收集1997～2004年收治我科的99例急性PTE患者的临床资料。进行长期随访,包括死亡、复发、慢性栓塞性肺动脉高压形成。对影响预后的因子进行相关分析。结果99例患者中,住院死亡2例(2.0%),失访7例(7.1%),共随访90例,随访时间(4.6±2.0)年。随访90例患者中,死亡10例(11.1%),PTE复发13例(14.4%),慢性栓塞性肺动脉高压10例(11.1%)。单因素χ2检验显示治疗前PaO2<60mmHg和肺动脉收缩压(SPAP)>50mmHg、治疗后栓塞面积>30%和SPAP>40mmHg与远期临床事件的发生有关(P<0.05)。多因素非条件logistic回归分析显示治疗后SPAP>40mmHg与患者远期预后相关(P<0.01)。结论治疗后仍有右心室功能异常且肺动脉收缩压>40mmHg是影响急性PTE患者远期预后的重要因素之一。

Objective To evaluate the long - term outcome and its prognostic factors in patients with acute pulmonary thromboembolism （PTE）. Methods Ninety-nine patients with acute PTE were admitted and treated in our department from 1997 to 2004 and their data were retrospectively reviewed and followed. Close attention was paid to severe clinical events, including death, recurrent PTE and chronic thromboembolic pulmonary hypertension formation. Prognostic factors were extrapolated with univariate analysis and then multivariate analysis. Results Among the 99 patients ,2 （2. 0% ） patients died during in-hospital phase and 7 （7. 1% ） patients discontinued in the follow-up ,90 （90. 9% ） patients completed the long-term follow-up with a mean time of 4. 6 ± 2. 0 years. Ten （11.1% ） patients died, 13 patients （ 14. 4% ） had recurrent PTE and 10 （ 11.1% ） patients had chronic thromboembolic pulmonary hypertension. Univariate analysis showed that PaO2 〈 60 mmHg and systolic pulmonary artery pressure 〉 50 mmHg prior to, and obstruction of pulmonary vasculature 〉 30% and systolic pulmonary artery pressure 〉40 mmHg post thrombolytie and （or） antithrombtic therapies were significantly correlated with the occurrence of severe clinical events （ P 〈 0. 05 ）. Multivariate analysis showed that systolic pulmonary artery pressure 〉 40 mmHg post thrombolytic and （or） antithrombtic therapy was the only risk factor that predicated occurrence of severe clinical events （19 〈 0. 01 ）. Conclusions Persistent right heart dysfunction as indicated by SPAP 〉 40 mmHg post therapies is an independent risk factor for the longterm outcome of acute PTE. More aggressive therapeutic methods may be needed in these clinical scenarios.