2000-2008年513例肺栓塞患者临床特征分析

Clinical Features in 513 Patients with Pulmonary Thromboembolism

目的探讨宁夏医科大学附属医院收治的急性肺栓塞（Pulmonary thromboembolism,PTE）患者的临床特征,以更好指导临床诊断与治疗。方法分析2000-2008年宁夏医科大学附属医院确诊的513例急性PTE患者的临床资料,比较大面积（包括次大面积）与非大面积急性PTE患者的症状、体征、确诊方法、实验室检查、预后转归的差别。结果急性PTE患者占同期住院病人的比例由2000年0.04%增至2008年0.31%。发病人数随年龄增长递增,51-80岁患者居多（68.4%）。医院内病死率由2002年的50%降至2008年的2.2%。汉族为430例（83.8%）,占住院汉族总人数的0.18%（430/240676）,回族75例（14.6%）,占住院回族总人数的0.25%（75/29577）。呼吸困难症状最为常见,占82.8%,大面积组PTE中症状（呼吸困难、晕厥等）、体征（紫绀、湿啰音等）以及实验室低氧血症、低碳酸血症、D-二聚体等指标增高,与非大面积组PTE差别有统计学意义（P〈0.05）。大面积PTE患者危险因素较非大面积增多。多层螺旋CT肺动脉造影在PTE诊断中的使用率由2001年50%增加至2008年98%。非大面积PTE组的治疗好转率（93.8%）优于大面积组（84.7%）。结论 2000年1月-2008年急性PTE的发生率呈上升趋势,高年龄发病人数所占比例高,高血压病、手术、心血管疾病患者为PTE的高发人群,大面积PTE较非大面积PTE临床症状重、合并危险因素多,预后差。

Objective To assess the accuracy of diagnosis and efficacy of management of Pulmonary thromboembolism（PTE） in hospitalized patients based on analysis of the clinical data.Methods513 patients with pulmonary embolism were retrospectively reviewed in the Affiliated Hospital of Ningxia Medical University from January 2000 to December 2008.By analyzing the clinical features,the laboratory findings,the diagnosis ways between massive and sub-massive PTE and non-massive PTE,differences would be compared.ResultsThe percentage of PTE in inpatients of the Ningxia Medical University increased from 0.04% on January 2000 to 0.31% on December 2008 PTE cases rised with age,especially between 51 and 80 year old（68.4%）.Overall hospital fatality rate of PTE declined from 50% in 2002 to 2.2% in 2008.The patients of Han ethnicity accounted for 83.8 %,and the percentage of Hui ethnicity was 14.6%.Dyspnea（82.8%） was the most frequent initial symptoms.The rate of clinical feature（cyanosis,increased P2,dyspnea）,a value of D-dimer,PaO2,PaCO2 and other risk factors in the massive and sub-massive PTE was higher than that of the non-massive PTE.The usage rate of computed tomography pulmonary angiography（CTPA） in PTE rised from 50% in 2001 to 98% in 2008.The clinical improvement rate in the non-massive PTE（93.8%） declined compared with the massive and sub-massive PTE（84.7%）.ConclusionThe incidence of PTE exponentially increased with age.High risk factors in PTE included hypertension,cardiovascular events,and operation.The massive and sub-massive PTE had more risk factors,more frequent initial symptoms and lower improvement rate than the non-massive PTE had.Advances in diagnosis and treatment was contributing to lower hospital fatality rate of PTE.