老年和非老年急性肺栓塞的临床特点对比研究

Comparative study of acute pulmonary embolism between the elderly and non - elderly people

目的比较分析老年和非老年急性肺栓塞（aeute pulmonary embolism，APE）的临床特点。方法对我院近8年来141例APE患者进行回顾性分析，根据年龄把141例患者分为两组，即老年（年龄≥60岁）组86例和非老年（年龄〈60岁）组55例，对两组患者的高危因素、临床特点、诊断及治疗等进行分析及比较。结果①老年APE71％，明显高于非老年组（29％）。②非老年组78．2％有明确的高危因素，而老年组仅有53．5％有明确的高危因素，两组比较差异有统计学意义（P〈0．01），两组常见高危因素包括外科手术、深静脉血栓、恶性肿瘤、慢性静脉机能不全、骨折及心力衰竭、脑卒中等。③两组临床表现均以呼吸困难最常见，与老年组相比，非老年组胸痛、咯血、晕厥、发热、下肢深静脉血栓体征更常见（P〈0．05）。④非老年组静脉溶栓治疗32．7％，明显多于老年组（15．1％），两组住院期间病死率比较差异无统计学意义。结论老年APE比非老年APE发生率更高，高龄是APE的独立危险因素；非老年APE患者大多数不仅有明确的高危因素，也有典型的临床表现，而老年APE则不同，所以临床医师对表现为呼吸困难的老年患者应警惕APE，以减少漏诊率。

Objective To analyze the clinical characteristics, diagnosis, therapy and prognosis of acute pulmonary embolism（APE） between the elderly and non -elderly people. Methods 141 APE patients treated in the Third Hospital of Peking University during recent 8 years were analyzed retrospeetively. 141 APE patients were classified to two groups： 86 patients, the age was older than 60 years old and 55 patients, the age was younger than 60 years old. The risk factor, clinical features, diagnosis and therapy of the two group patients were analyzed and compared. Results ①The elderly with APE accounted for 71% of all APE patients. ②the patients in two groups had specific risk factors, but the risk factors in younger group（78.2% ） were more common than those in older group （53.5%） （P 〈0.01 ）. The risk factors of two groups included surgery, deep venous thrombosis, malignant tumor, chronic venous insufficiency, bone fractures, heart failure and stroke. ③Among clinical manifestations of the two groups, the dyspnea was the commonest. Other manifestations including chest pain, hemoptysis, syncope, fever and deep vein thrombosis （DVT） of lower extremity in younger patients were more common than those in the elderly （P 〈 0.05 ）. ④The patients received venous thrombolysis in non - elderly people group was 32.7% , in old people group was 15.1%. There were no statistical differences in short -term mortality rate of two groups in hospital. Conclusion The incidence rate of APE was higher in the elderly than in non - elderly people. The advancing age was the independent risk factor of APE. Most younger patients with APE had not only risk factors but also typical clinical manifestations, and most the elderly had neither risk factors nor typical clinical manifestations. So the physician should pay more attention to the elderly with dyspnea in order to decrease missed diagnosis of APE.