慢性心功能不全合并肺血栓栓塞症65例临床分析

Clinical analysis of Chronic heart failure with pulmonary thromboembolism

目的探讨慢性心功能不全合并肺血栓栓塞症(PTE)的临床特点和诊断思路。方法分析住院的65例慢性心功能不全合并肺血栓栓塞症患者的临床资料。结果 65例PTE患者中活动性胸闷、呼吸困难突然加重59例(93.8%),动脉血气PaCO2下降或呈Ⅰ型呼吸衰竭表现43例(66.2%),D-二聚体>0.5mg/L(ELISA法)100%。超声心动图检查有三尖瓣反流和肺动脉高压37例(56.9%)。结论慢性心功能不全患者最重要的临床症状是活动性胸闷、呼吸困难突然加重,经强化抗心衰等治疗肺部啰音消失或减少,但症状不能完全缓解或甚至有加重趋势,常合并Ⅰ型呼吸衰竭。临床上可以根据这些特点提出疑诊,再选择肺血管薄层增强CT扫描进一步确诊。

Objective To investigate the clinical features and diagnosis of Chronic heart failure with pulmonary thromboembolism（PTE）.Methods Clinical datas of 65 cases of chronic heart failure with PTE hospitalized in our hospital during 2003-2011 were retrospectively analyzed.Results Patients with chronic heart failure with PTE had some clinical symptoms： chest tightness and suddenly increased difficulty breathing difficulty（93.8%）,decline in PaCO2 or type Ⅰ respiratory failure（66.2%）,D-dimer over 0.5mg/L（100%）,tricuspid regurgitation and pulmonary hypertension（56.9%）.Conclusion The most important clinical symptoms of Patients with chronic heart failure with PTE were active chest tightness,suddenly increased difficulty breathing difficulty,pulmonary rales disappeared or reduced but not completely relieve the symptoms or even has increasing trend,type Ⅰ respiratory failure.Clinically suspected based on these characteristics made,and then select the pulmonary vascular thin-enhanced CT scan further confirmed.