肺血栓栓塞诊治体会

Experience of Diagnosis and Treatment of Pulmonary Thromboembolism Cases

目的总结10例肺栓塞患者的诊治经验。方法分析我院2007年6月—2008年6月诊治的10例肺血栓栓塞患者的的临床表现、胸部影像学特征及实验室检查结果,总结肺血栓栓塞诊治经验。结果10例肺血栓栓塞患者的的临床表现主要是胸闷,胸痛、气短,憋气,呼吸困难,心悸,其次是晕厥,下肢疼痛肿胀及PTCA手术史;实验室检验:10例患者D-二聚体监测全部阳性,阳性率为100%;血气分析,主要表现低PaCO2和低氧血症;心电图检查,超声心动图检查及四肢血管彩超检查提示都有一定的异常;9例患者行胸部增强CT扫描,全部明确诊断为肺动脉栓塞;10例患者经溶栓及抗凝治疗,9例治愈,1例死亡。结论对重症,危重患者及高危险患者常规行血气分析、D-二聚体、心电图、DVT、超声心动图、X线检查等全面综合分析能有效提高肺栓塞诊断率,胸部增强CT检查能明确诊断,早期溶栓及抗凝治疗可以达到较好的治疗效果。

Objective To summarize the experience of diagnosis and treatment of 10 pulmonary embolism cases.Methods Analysis of clinical manifestations,chest imaging features and laboratory test results of 10 pulmonary thromboembolism patients in our hospital from June 2007 to June 2008.Results Clinical manifestations of 10 pulmonary thromboembolism patients were mainly chest tightness,chest pain,shortness of breath,difficulty in breathing,heart palpitations,followed by syncope,lower extremity swelling and pain,and PTCA surgery history;laboratory tests： D-dimer test： results of 10 patients were all positive,the positive rate was 100%;results of blood gas analysis mainly appeared low PaCO2 and hypoxemia;ECG,echocardiography and limbs of vascular color Doppler ultrasound examination all had a certain degree of abnormality;9 patients were all diagnosed as pulmonary embolism clearly with chest enhanced CT check;10 patients were therapied by thrombolysis and anticoagulation,9 patients were cured and 1 died.Conclusion Blood gas analysis,D-dimer,ECG,DVT,echocardiography,X-ray examination,such as a comprehensive and aggregate analysis can improve the diagnosis rate of pulmonary embolism effectively,enhanced chest CT check is helpful for clearly diagnosis,early thrombolysis and anticoagulant therapy can achieve a better therapeutic effect.