急性肺栓塞的临床特点及诊治方法

Clinical Features and Therapeutic Approaches of Acute Pulmonary Embolism of 39 Cases

【目的】分析总结急性肺栓塞的临床特点，提高对该病的认识，减少漏诊率、误诊率和病死率。【方法】对本院39例诊治为急性肺栓塞的临床表现、诊断和治疗方法进行回顾性分析。【结果】肺栓塞缺乏临床特异性表现，常被误诊为冠心病、慢性阻塞性肺疾病、肺炎等。D-二聚体大于500μg／L者占92．3％，血气分析P02〈80mmHg占89．7％，螺旋CT肺段动脉以上动脉血栓者占79．5％。溶栓加抗凝治疗组有效率为81％，单纯抗凝治疗组有效率为66．7％。【结论】肺栓塞易漏诊和误诊，血气分析、D-二聚体、UCG可作为急性肺栓塞的初筛检查指标，溶栓加抗凝疗法治疗PE优于单纯抗凝疗法。

[Objective]To analyze and summarize the clinical features of acute pulmonary embolism for im- proving the diagnosis and treatment and lowering the rate of missed diagnosis, misdiagnosis and mortality. [Methods]Thirty nine cases of acute pulmonary embolism in our hostpital from September 2003 were enrolled. The clinical manifestations,diagnosis and therapeutic methods were analyzed retrospectively. [Results] Acute pulmonary embolism had less specific clinical manifestations, so it was easily diagnosed as coronary artery dis- ease, chronic obstructive pulmonary, pneumonia, etc. The ratio of cases whose D-dimer was more than 500 μg/L was 92.3%. The ratio of cases whose PO2 was lower than 80mmHg was 89.7%. The ratio of cases with superior pulmonary artery embolism was 79.5%. The effective rate of patients received emergency thrombolytic therapy and anti-coagulation therapy was 80 %, while the rate of patients received only anti-coagulation ther- apy was 65%. [Conclusion]Acute pulmonary embolism is apt to be missed diagnosed and misdiagnosed. The blood gas analysis,Ddimer and UCG may be the indictors for primary examination in acute pulmonary embolism. Thrombolytic therapy combined with anti coagulation therapy is better than only anti-coagulation therapy.