不同年龄段肺血栓栓塞症患者的临床特征及预后影响因素分析

Clinical characteristics and prognostic factors of pulmonary embolism in different age groups

目的 探讨不同年龄段肺血栓栓塞症（pulmonary thromboembolism,PTE）患者的临床特点及预后影响因素. 方法 对2004年1月至2009年7月广州呼吸疾病研究所经CTPA和（或）肺通气灌注扫描诊断的209例PTE患者进行回顾性分析. 结果 209例中男124例（59.3%）,女85例（40.7%）,年龄15～91岁,平均（58.3±18.6）岁.其中老年组（≥65岁）95例（45.5%）,非老年组（≤65岁）114例（54.5%）,41～64岁者71例（34.0%）,≤40岁者43例（20.6%）.PIE合并的基础疾病依次为发病前有制动/卧床史（88例,42.1%）、COPD（51例,24.4%）、肿瘤（45例,21.5%）和高血压（45例,21.5%）;常见症状为呼吸困难（175例,83.7%）、咳嗽（155例,74.2%）、胸痛（61例,29.2%）、咯血（32例,15.3%）及晕厥（8例,3.8%）等;186例（92.1%）患者D-二聚体阳性,（37.8%）79例静脉超声显示下肢深静脉血栓形成,其中54.0%（81/150）存在肺动脉高压,16.7%（35例）进行溶栓治疗,169例（80.9%）进行抗凝治疗,病死率为6.7%.老年患者常合并多种基础疾病,如COPD、肿瘤和高血压;发生胸痛、咯血、发热、低血压的比例较非老年组为少,但咳痰、肺部啰音和下肢浮肿较非老年组多;老年组发生大面积栓塞和肺梗死的比例较非老年组低,而有典型心电图表现的比例高;老年组溶栓的比例较非老年组少,但疗效与非老年组无明显差别.PaO2〈60 mm Hg（1 mm Hg=0.133 kPa）、肺部有湿性啰音、中性粒细胞百分比异常、未经抗凝溶栓治疗、病情危重及合并肿瘤和肺炎是PTE预后不良的影响因素. 结论 PTE的临床表现多样,尤其是老年PTE患者,常合并多种基础疾病,且临床表现不典型,应高度警惕,加强监测,积极治疗.

Objective To explore the clinical characteristics of pulmonary embolism（PE）in different age-groups and to analyze prognostic factors of PE. Methods Data of 209 PE patients diagnosed in our hospihal from 2004 to 2009 were reviewed retrospectively. Results Of the 209 patients with PE,95 subjects （45.5%） were over the age of 65,and 114 were≤65 years.The third leading comorbidity were activity limitation that were banding in bed.chronic obstructive pulmonary disease,neoplasm and hypertension,accounting for 42.1%,24.4% and 21.5%,respectively.The typical clinical presentations included dyspnea（83.7%）,cough（74.2%）,chest pain（29.2%）,haemoptysis（15.3%）and syncope （3.8%）.In 186（92.1%）patients,D-dimer wag above the normal level,37.8%（79）and 54.0%（81/150） subjects were found having got a venous thrombosis in lower extremity and pulmonary hypertension,respectively by using ultrasonic visualization.16.7%（35）and 80.9%（169）had received thrombolytic and anticoagulant therapy.respectively.The death rate of PE was 6.7%.A difierence in clinical characteristics wag obserred between younger and older patients.The later had more comorbidity such as COPD.neoplasm and hypertension,the older patients had fewer complaints of chest pain,haemoptysis,fever,hypotension and typical electrocardiogram（ECG）,but had more cough with sputum,pulmonary rales and lower extremity edema.in comparison to the younger patients.The older PE patients were less likely to suffer from be thrombosis and pulmonary infarction,and to received thrombolytie therapy. Multivariate logistic regression showed that PaO_2 〈 60 mm Hg（1 mm Hg = 0. 133 kPa）, having pulmonary rales, having abnormal neutrophilic granulocyte counts, not receiving thrombolysis and anticoagulant therapy, suffering from emergency rescue, having comobidities with tumor and pneumonia were important prognostic factors. Conclusion The clinical features of PE were various and non-specific. More attention should be paid to PE patients, in particular to older patients who usually had more comorbidities and non-specific clinical manifestations.