单中心医疗机构20年肺栓塞发病的回顾性分析

Analysis of the occurrence of pulmonary embolism in 20 years in single medical center

目的评价单中心医疗机构20年间肺栓塞（PE）发病情况及其与患者基础疾病的相关性。方法回顾性分析1989年1月至2009年1月在解放军总医院住院治疗的PE患者临床资料，分析PE患者发病规律及合并的基础疾病，并对PE发病各影响因素进行相关性分析。结果20年间共救治505例PE患者，其发病率呈逐年增加趋势，2004年后病例陡然增加[61．2％（309）比38．8％（196）]；PE发病年龄段以41～60岁为主，各年龄段均有发病；男女比例为1．52：1，男性发病率明显高于女性[60．4％（305）比39．6％（200）3。505例PE患者中出现呼吸困难、胸痛、咯血三联征者占40．0％；其中呼吸困难（100．0％）、咯血（52．1％）、胸痛（40．0％）为首要症状。31．1％的PE患者伴有深静脉血栓形成（DVT）史，19．8％伴有静脉曲张，9．5％近期（≤30d）伴有手术史，22．0％伴有肿瘤，3．6％近期（≤4d）罹患脑血管疾病，17．4％伴各种感染，10．1％伴有原发性肺动脉高压，16．8％伴有各类心肺疾病史；经多因素Logistic回归分析发现，PE的发生与手术外伤、DVT、肿瘤呈显著相关性[相对比值比（95％可信区间），OR（95％CI，）分别为4．540（2．186～9．443）、0．325（0．155～0．682）、2．610（1．020～6．708），P〈0．05或P〈0．01]；与服用避孕药、原发性肺动脉高压、脑血管意外发生有一定相关性[OR（95％C，）分别为0．297（0．078～1．126）、3．210（0．855～12．110）、2．939（O．862～10．020），均P〉0．053，与年龄、感染发生的相关性不显著[0尺（95％CI）分别为1．041（0．674～1.607）、0.820（0．410～1．665），均P〉0．053。结论PE不易诊断，但随着对PE认识的提高、诊断意识的增强，PE确诊率逐年增加。对于有手术外伤史、DVT及肿瘤的患者如出现原因不明的呼吸困难、胸痛、咯血等临床表现时，应警惕发生PE的可能并及时进行有关检查，可有效减少PE早期误治并提高PE患者存活率。

Objective To evaluate the correlation of pulmonary embolism （PE） and original diseases by retrospectively analysis of the patients for 20 years in single medical center. Methods Five hundred and five patients with PE were admitted and treated in General Hospital of Chinese PLA from January 1989 to January 2009, and their clinical data were retrospectively reviewed to analyze the risk factors of PE and the correlations of PE with the original diseases. Results Of the 505 patients with PE in the past 20 years, the incidence of PE was increased year by year, especially it increased spectacularly after the year of 2004[61.2% （309） vs. 38.8% （196）~. It was found to be most prevalent in patients of 41 60 years old. Its incidence in males was 1.52 folds higher than that of the females （60.4% （305） vs. 39.6% （200）~. Dyspnea, chest pain and hemoptysis were the initial symptoms in the PE patients. Among the 505 patients, 40.0% of them complained dyspnea with chest pain and hemoptysis. Among them, dyspnea occurred in 100.0% of patients, hemoptysis in 52.1%, and chest pain in 40. 0% In 31.1% of the patients if was complicated with deep venous thrombosis （DVT）, 19.8%of them suffering from varicosity, 9.5% of them had the history of surgery less than 30 days before, 22.0% of them suffering from neoplasm, 3.6% of them were accompanied with cerebrovascular disease within 4 days, 17.4% of them were accompanied with infection, 10.1% of them were accompanied with primary pulmonary hypertension, and 16.8 % of them were accompanied with heart diseases. Multivariate analysis showed that the history of surgery, ＂DVT and t neoplasm had significant correlation with the occurrence of PE [odds ratio （95% confidence interval）, OR （95%CI） was 4.540 （2.186-9.443）, 0.325 （0.155 0.682）, 2.610 （1.020 6.708）, P〈0.05 or P〈0. 013, while oral contraception, primary pulmonary hypertension and cerebrovascular disease showed a less significant correlation with the occurrence of PE [OR （95%CI） was 0. 297 （0. 078 1. 126）, 3. 210 （0. 855 12. 110）, 2. 939 （0. 862 10. 020）, all P〉0. 053. The age and infection did not show significant correlation with the occurrence ofPE （OR （95%CI） was 1.041 （0.674-1.607） and 0.820 （0.410 1.665）, both P〉0. 053. Conclusion The PE is difficult in diagnosis, but with increasing cognizance, the diagnostic rate of PE has been increased. Patients with history of surgical operation, DVT or neoplasm, who complain dyspnea without known cause, chest pain or hemoptysis, should be subjected to further examinations, as to confirm the diagnosis of PE, then the survival rate of the patients with PE may be elevated.