121例肺动脉栓塞的临床分析

Pulmonary embolism:a 120-case analysis

目的:探讨肺动脉栓塞(PE)患者的临床表现、诊断、治疗和预后。方法:对本院121例PE患者资料行回顾性分析,着重分析患者的临床表现、诊断、治疗和预后。结果:PE患者有增加趋向,存在易患因素,下肢深静脉血栓形成为最常见的因素。临床表现多为不明原因的呼吸困难、胸痛、咯血、咳嗽、晕厥及休克等。溶栓治疗24例,存活21例;介入治疗11例,存活8例;单纯抗凝治疗86例,存活77例。结论:PE患者症状、体征和临床表现不完全一致,提高对PE的认识,对及时诊断PE具有重要意义;对疑诊的患者应常规筛查心电图、血气分析、血液生化、D-二聚体及超声心动图;高度怀疑者进一步检查肺部螺旋CT增强扫描及肺动脉造影。尿激激酶静脉溶栓及低分子肝素及华法林抗凝治疗效果良好。

Objective： To summarize the clinical manifestations, diagnosis, treatment and prognosis of pulmonary embolism （PE）. Methods： The data of 121 PE patients were reviewed with focus on clinical manifestations, diagnosis, treatment and prognosis. Results： The incidence of PE seemed to be increasing over time among these patients, in whom a number of risk factors were identified. Deep venous thrombosis of lower limbs was one of the most common factors. PE was frequently manifested by dyspnea, chest pain, hemoptysis, cough, syncope and shock. 21,8 and 77 patients survived thrombolytie therapy （n = 24 ）, intcrventional therapy （ n = 11 ） and simple anticoagulant therapy （ n = 86 ）, respectively. Conclusion： In PE, the clinical symptoms may not always be consistent with signs. Improved awareness of PE can be important for early diagnosis. Routine screening with ECG,blood gas analysis, blood biochemistry, D-dimer test and eehocardiography is advisable for suspected cases. In those highly suspected for PE, further evaluations with enhanced spiral CT and pulmonary angiography should be necessary. Intravenous use of thrombolytic urokinase, low molecular heparin and anticoagulative Warfarin may have good effects for PE patients.