以晕厥等为首发症状的癌症并发肺栓塞临床分析

Clinical Analysis of Cancer Patients Complicated by Pulmonary Embolism to Start with Syncope

目的分析癌症并发肺栓塞的临床特点,指导临床早期发现肺栓塞,早期治疗。方法 2006年3月至2011年1月间,连续纳入年龄在31～85岁,在我院心脏中心病房及门诊就诊,并确诊的癌症并发肺栓塞的惠者11例。分析引发肺栓塞的癌症病因构成及相关的临床表现。结果患者平均年龄63±17岁。男8例(81.8%),女3例(27.3%)。11例患者中胃癌3例(27.3%),前列腺癌2例(18.2%),肺癌2例(18.2%),卵巢癌2例(18.2%),乳腺癌1例(9.1%),及结肠癌1例(9.1%)。11例患者并发肺栓塞的临床表现有晕厥3例(27.3%)、直立位低血压3例(27.3%)、窦性心动过速2例(18.2%)、胸闷气短7例(63.6%)、胸痛4例(36.4%)、下肢水肿1例(9.1%)、紧张焦虑情绪1例(9.1%)。所有患者均经积极的低分子抗凝治疗及随后的华法林口服治疗症状消失。本观察中无因肺栓塞死亡的病例。结论癌症是肺栓塞发生的高危人群,尤其是本研究中观察到的上述癌症类型可能更容易合并肺栓塞。这些患者出现晕厥等本研究观察到的上述症状时更应警惕肺栓塞的筛查。

Objective To analyse the clinical charateristics of cancers complicated by pulmonary embolism in order to detect pulmonary embolism early and start therapy early. Methods We enrolled 11 inpatient and outpatient department patients aged 31-85years old continuously from March, 2006 to January, 2011. All patients are diagnosed with cancers. All cancers are confirmed by pathological examination, lab tests, physical checkup and clinical presentations. Eight cases are diagnosed with pulmonary embolism by pulmonary ventilation/ perfusion imaging, 3 cases are diagnosed by spiral computed tomographic pulmonary angiography. We analysed the contributed cancer etiology and their related clinical presentation. Results Mean age is 63~17 years old. Eight cases are male（81.8%）, three cases are female（27.3%）. Gastric cancer（27.3%）, prostate cancer（18.2%）, breast cancer（9.1%）, ovarian cancer（18.2%）, colon cancer（9.1%）, pulmonary cancer（18.2%） are the most frequently seen cancers complicated by pulmoary embolism. Related clinical presentations are syncope（27.3%）, orthostatic hypotension（27.3%）, sinus tachycardia（18.2%）, dyspnea（63.6%）, chest pain（36.4%）, leg and ankle edema（9.1%）, anxiety and tension emotion（9.1%）. All patients are anticoagulated fully by low molecular weight heparin and oral warfarin. Symptom disappeared and no patients died during the study. Conclusion Cancer is a very important risk factor for pulmonary embolism, especially the cancer types found in this study. Be aware of the symptoms found in the study in order to screen pulmonary embolism.