肺动脉栓塞17例临床分析

Clinical analysis of 17 cases with pulmonary embolism

目的:探讨肺动脉栓塞(PE)患者的临床特征。方法:回顾分析17例肺动脉栓塞患者的临床资料,判断影响早期诊断的主要因素。结果:17例急性患者中男女之比为3.25/1(13/4);15例(88.23%)表现为胸痛;呼吸困难12例(70.59%);下肢肿痛11例(64.70%);低氧血症12例(70.59%);心电图出现SⅠQIIITIII变化4例(23.52%);螺旋胸片CT显示有靠近胸膜散在云片状阴影10例(58.82%),螺旋CT显示肺动脉充盈缺损8例(47.06%);肺动脉造影检查,表现为多段多叶肺动脉阻塞、充盈缺损11例(64.70%)。结论:有长期卧床、深静脉血栓、下肢骨折、手术、高龄、妊娠和分娩、肿瘤、肥胖、高血压等基础疾病的患者,出现不明原因的呼吸困难、胸痛、晕厥、咯血、一过性血压降低、紫绀、氧分压逐渐降低等;胸片出现肺楔形影,胸部CT检查有靠近胸膜的散在片状影,尤其临床出现严重低氧血症,用心肺疾病不能解释;心电图呈现一过性SⅠQⅢTⅢ或QⅢTⅢ,V1～V5导联T波倒置;心脏彩超提示:右心室增大,肺动脉高压形成。是明确PE较有意义的指标,掌握其临床特征是提高早期诊断的关键。

Objective To evaluate the clinical characters of pulmonary embolism（PE）.Method The clinical data of 17 patients with PE were retrospectively analyzed,and the main characters for early diagnosis were evaluated.Results Total 17 patients were enrolled in this study,the ratio between male and female was 3.25：1（13 /4） ;chest pain was presented in 15 patients（88.23%） ;dyspnea and hypoxemia were presented in approximately 70% of the patients,whereas leg swelling and pain occurred in less than 70% of the patients（64.70%）.Chest radiographic abnormalities were found as pulmonary infiltrates near pleural in 10 patients（58.82%） and CT angiogram showed multisegmental and multilobar pulmonary artery filling defects in 8 patients（47.06%）.SI-QIII-TIII electrocardiogram pattern and T wave inversion in V1 ～ V5 was observed in 23.52% of patients.Conclusion The diagnosis of pulmonary embolism should be considered in any patients who present with shortness of breath,chest pain,syncope,hemoptysis,hypotension,cyanosis and arterial hypoxemia,especially unexplained severe hypoxemia.The risk of PE in cases with prolonged bed rest or DVT.Surgery and fractures of the femur and tibia are associated with the high risk.Pregnancy,malignancy,obesity and hypertension are all involved in.The following data may provide valuable adjunctive information.Wedge shaped infiltrates in chest radiographs,infiltrates near pleural showed in spiral computed tomograph,a SI-QIII-TIII pattern and T wave inversion in V1 ～ V5,pulmonary hypertension and right ventricular hypertrophy.The recognize of these risk factors,clinical symptoms and standard laboratory evaluation can facilite the early diagnosis of PE.