急性非大面积肺血栓栓塞症9例随访分析

Follow-up analysis of 9 cases with acute non-massive pulmonary embolism

目的探讨9例急性非大面积肺血栓栓塞症(PTE)患者的临床特点、抗凝治疗3月或6月的转归。方法分析9例经多排螺旋CT肺动脉造影(CTPA)确诊的急性非大面积PTE患者的临床特点,对于首次发作伴随可去除危险因素(如手术、长期制动、长途乘车、长时间服用糖皮质激素等)的患者抗凝治疗3月,对于特发性或存在恶性肿瘤等持续性危险因素的患者抗凝治疗6月,在抗凝治疗期间监测国际标准化比值(INR),使其稳定在2.0～3.0,且分别自抗凝治疗起随访6月和9月。结果 1例(11.1%)6月抗凝治疗组患者死亡(死于胆囊癌晚期所致全身衰竭),8例(88.9%)3月抗凝治疗组患者均痊愈,随访期间未新发血栓。结论对于首次发作的伴随可去除危险因素的急性非大面积PTE患者选择抗凝治疗3月是安全有效的,血清D-二聚体是急性PTE可靠的初筛检查,多排螺旋CT肺动脉造影为可靠的确诊急性肺栓塞(PE)的检查。

Objective To investigate the clinical features of 9 cases with acute non-massive pulmonary thromboembolism（PTE）,and the prognosis after anticoagulant treatment for 3 or 6 months.Methods The clinical features with 9 cases with acute non-massive PTE diagnosed by multi-slice spiral CT pulmonary angiography were analyzed.The patients who were the first attack with risk factors which could be removed（such as the operation,long-term braking,long-distance travel,taking corticosteroids for a long time,etc.）were schemed of anticoagulant treatment for 3 months,the patients who were idiopathic or with persistent risk factors such as malignancy were schemed of anticoagulant treatment for 6 months.International normalized ratio（INR）values were monitored during anticoagulant treatment to stabilize it between 2.0-3.0,and the patients were followed up for 6 or 9 months from the date of anticoagulant treatment.Results One patient（11.1%）schemed of anticoagulant treatment for 6 months died（due to systemic failure with advanced gallbladder carcinoma）,eight patients（88.9%）schemed of anticoagulant treatment for 3 months were cured,there was no new thrombus during the follow-up.Conclusions For the first attack acute non-massive PTE patients with the risk factors which can be removed,anticoagulant treatment for 3 months is safe and effective.Serum D-dimer is a reliable screening examination for acute PTE,multislice spiral CT pulmonary angiography is a reliable inspection in diagnosis of acute pulmonary embolism（PE）.