老年急症内科住院患者肺动脉血栓栓塞调查

Prevalence of pulmonary thromboembolism in elderly patients hospitalized for acute medical illness

目的前瞻性地观察老年内科急症住院患者90 d肺动脉血栓栓塞(肺栓塞)的患病率。方法本研究为前瞻性多中心描述性研究,自2006年6月～2007年1 2月在北京等地区41个参研中心连续入选符合标准的患者共626例,分别于入选第3周及入选第90天随访。入选标准为年龄≥60岁,卧床≥3 d且伴有下列疾病之一者:慢性心力衰竭(心功能:NYHAⅢ～Ⅳ级)、急性心力衰竭、呼吸衰竭、急性感染性疾病、急性风湿性疾病、脑卒中、急性冠状动脉综合征。近期有外科手术或外伤者除外。观察终点事件为客观检查证实的肺栓塞、静脉血栓栓塞及全因死亡。结果剔除数据不完整的病例后,用于统计分析的共607例,男性占64.3%,平均年龄(77.2±7.6)岁。90 d随访期间确诊肺栓塞1 5例,占2.5%,均发生在入选后3周内,其中致死性肺栓塞2例,占13.3%。静脉血栓栓塞症59例,占9.7%;死亡41例,占6.8%。结论我国老年内科急症住院患者90 d内肺栓塞患病率与既往在白种人中观察得到的数据相近,在临床实践中应引起重视。如何进行安全有效的预防是我们面临的重要问题。

Objective To determine the prevalence of PTE in elderly patients hospitalized for acute medical illness. Methods A prospective, multi-center, observational study was conducted from June 2006 to December 2007. A total of 626 eligible patients were enrolled consecutively in 41 medical centers. All had 90-day follow-up. Inclusion criteria were ≥60 years of age,staying in bed for ≥3 days, having one of the following conditions ： congestive heart failure （NYHA Ⅲ -- Ⅳ ）, acute heart failure, respiratory failure, acute infective diseases, acute rheumatic diseases, stroke, or ACS. Patients had recent surgical operation or injures were excluded. Main endpoints were objectively confirmed PTE,venous thromboembolism（VTE） ,and all-cause death. Results 607 partici- pants were used for analysis after excluding those with incomplete data. Their mean age was 77.2±7.6 years,and 64.3% were males. Of them,15（2.50%） had objectively confirmed pulmonary embolism during 90-day follow-up. All of these events occurred within 3 weeks after enroll- ment. Of them, 13% （2 cases） were fatal PTE. The total VTE events were 59 （9. 7%） and 41 （6.8%） patients died during 90-day follow-up. Conclusions The present study showed that prev alence of PTE in elderly patients hospitalized for acute medical illness during 90-day follow-up was consistent with previous studies in white population. Great caution must be paid in clinical practice. Application of safe and effective prophylaxis remains a critical challenge.