只有经肺动脉造影才能确诊肺栓塞吗?——附23例急性肺栓塞临床及治疗分析

Is pulmonary angiography required only for patients to make the diagnosis of pulmonary embolism?Clinical treatment analysis of 23 patients with pulmonary embolism

目的：为提高肺栓塞临床诊断的正确率，为减少误诊误治提供依据。方法：对我院１９７８年～１９９５年确诊的资料完整的２３例肺栓塞病例进行分析及文献复习。结果：２３例中除３例致死性肺栓塞患者中的２例死亡外，其余２１例均存活。其中１例进展为慢性肺栓塞，行下腔静脉置网术；１例在肝素治疗第９日出现严重血小板减少，对侧肺再发栓塞；１例口服华法令期间出现血尿。无一例行肺动脉造影。结论：当基层医院不能即刻提供肺灌注扫描或肺动脉造影时，简单的临床手段（包括Ｘ线胸片、心电图、动脉血气分析结合临床表现）即能诊断肺栓塞，从而尽早进行抗凝治疗，提高治愈率；只有对临床及肺灌注扫描仍然不能确诊的患者才需施行肺动脉造影。

Objective:To provide the evidence for improving diagnosis of pulmonary embolism and decrea sing misdiagnosis and mistreatment.Methods:Clinical data from 23 patients admitted to Tianjin Chest Hospital between 1978 and 1995 were analyzed together with literature review.Results:Due to the prompt diagnosis and the use of anticoagulants,two patients died and 21 cases survived,one case occurred severe thrombocytopnia on the ninth day after heparin infusion,one presented hemuresis,one case developed chronic pulmonary embolism and surgical interruption (insertion of intraluminal filters) of the inferior vena cava was performed,no one was performed pulmonary angiography.Conclusions:When perfusion lung scan and pulmonary angiography are not promptly available in primary hospital,simple clinical procedures (including chest radiogram,EKG,ABG and clinical manifestations)may be useful to make the diagnosis of pulmonary embolism early,accurately at low cost and decide on therapeutic management.The pulmonary angiography is required only for patients in whom clinical manifestations and perfusion scan assessment are discordant.