急性肺栓塞患者治疗及长期随访结果分析

Treatment and Long-Term Follow-Up of Acute Pulmonary Embolism

目的急性肺栓塞(PE)是临床常见的心血管急症,危害极重。本研究通过对本院疑诊、确诊PE患者的资料进行回顾,以总结PE的治疗经验。方法检索本院1997年8月—2009年6月出院诊断为PE的病例,记录相关资料,并对出院患者进行电话随访。结果 83例患者确诊为PE,1例患者住院死亡,38例患者接受了随访,其中8例死亡,其他患者失访。38例患者接受溶栓联合抗凝治疗,1例死亡;46例单独接受抗凝治疗。已知临床结局的39例患者中,接受或无接受溶栓治疗组比较,病死率发生的相对危险度(RR)=1.04,95%CI(0.33,3.28);长期坚持服用与无坚持服用华法林组比较,患者病死率RR=1.56,95%CI(0.38,6.41),差异均无统计学意义。结论对确诊PE患者,溶栓联合抗凝和单纯抗凝治疗存在争议,长期服用华法林的依从性也较差。

Objective Acute pulmonary embolism（PE） is a common cardiovascular emergency condition in clinical practice,which has a severe outcome.We reviewed the sources of patients suspected or diagnosed with PE in our hospital and tried to conclude experiences on diagnosing and treating PE.Methods The records from August,1997 to June,2009 were reviewed,and useful information was recorded.For outpatients we followed up by phone calls.Results Eighty three patients were diagnosed with PE,among whom one died.Among thirty eight patients who were accepted follow up by phone calls,eight patients died.Other patients were lost to follow up.Thrity eight patients treated with thrombolytic,one died in hospital stay.The other forty six patients treated with anticoagulation alone.In thirty nine patients whose clinical outcomes were clear,the relative risk（RR） of mortality of patients treated with thrombolytic,comparing to those with anticoagulation alone,was 1.04,95%CI（0.33,3.28）.The RR of mortality of patients treated with warfarin for long-stand,comparing to that of patients withdrawn by themselves,was 1.56,95%CI（0.38,6.41）.The differences of both results were out of significant.Conclusion For patients diagnosed with PE,thrombolysis or anticoagulation was still controversy.The compliance of long-term warfarin treatment was still low.