肺血栓栓塞症163例临床对比分析

Clinical analysis of 163 cases of pulmonary thromboembolism

目的探讨肺血栓栓塞(PTE)规范化诊治方案在PTE诊治中的作用和意义。方法回顾性分析广西医科大学第一附属医院1972-01-01—2006-12-31共35年住院的163例PTE患者的临床资料。将入选病例以参加"十五"国家科技攻关课题"PTE规范化诊治方法的研究"为时间点将所有PTE病例分为非规范化诊治组和规范化诊治组,进行两组病例资料的对比分析。结果最主要的危险因素和基础病是深静脉血栓形成,其次是手术、外伤、骨折、肿瘤等。呼吸困难是最主要的临床症状,两组呼吸困难的发生率分别是92.5%和84.6%。规范化诊治组较非规范化诊治组PTE的诊断例数明显增加,并呈逐年增多趋势;确诊比例增高(P<0.01);确诊时间缩短(P<0.01);规范化治疗的病例增多(P<0.01);住院病死率降低(P<0.01)。结论采用PTE的规范化诊疗程序,极大地推动了PTE的诊治工作。

Objective To explore the role and significance of standardized scheme for diagnosis and treatment of pulmonary thromboembolism （PTE）. Methods The clinical data of 163 consecutive PTE patients who were treated in our hospital from Jan. 1972 to Dec. 2006 were retrospectively reviewed. The patients were divided into group A and group B based on the time of application of standardized treatment and diagnosis for PTE. The clinical data of the two groups were analyzed and compared. Results The main risk factors included deep vein thrombus,operation,injury, fracture and tumors,etc. Dyspnea was the most important clinical symptoms. The incidences of dyspnea in group A and B were 92. 5% and 84. 6% ,respectively. The diagnostic case and the ratio of final diagnosis in group B was increased compared to those in group A on an annual basis. The median time for diagnosis was shortened（ P 〈 0. 01 ）and the in-hospital mortality was decreased compared with group A （P 〈 0. 01 ）. Conclusion The introduction of PTE standardized treatment and diagnosis scheme have greatly promoted the diagnosis and treatment of pulmonary thromboembolism.