急性肺栓塞67例临床分析

ACUTE PULMONARY EMBOLISM:CLINICAL ANALYSIS OF 67 CASES

目的了解急性肺栓塞的流行病学资料,以提高急性肺栓塞的诊治水平。方法对2008年1月—2010年10月在我院呼吸内科住院治疗、确诊为急性肺栓塞67例病人的一般资料、危险因素、临床表现、辅助检查、误诊情况、危险分层及疗效评估进行统计分析。结果本组病人男33例,女34例,平均年龄(53.2±15.1)岁。危险因素以近期手术(25.4%)最常见,临床表现呼吸困难多见(88.1%)。辅助检查:D-二聚体检查阳性率为97.0%,肺动脉造影(CTPA)阳性率为70.6%,核素肺通气-灌注扫描(ECT)敏感性高。首诊误诊率达55.2%。低危组治疗有效率为91.4%(32/35);中危组(存在右心功能不全和(或)心肌损害)溶栓+抗凝治疗的有效率为80.0%(4/5),单纯抗凝治疗的有效率为94.7%(18/19);高危组(存在低血压或休克)治疗有效率为100%(5/5)。结论肺栓塞临床误诊率高,应综合危险因素、临床表现及D-二聚体等初查结果确定疑诊病人,并尽快行ECT及CTPA检查以确诊。高危病人若无禁忌均应尽早溶栓治疗,低、中危病人单纯抗凝治疗即可取得良好疗效。

Objective To analyze epidemiological information of acute pulmonary embolism（PE） so as to raise the level of diagnosis and therapy of this condition.Methods The clinical data of 67 patients with PE treated in Department of Respirology in our hospital,from Jan.2008 to Oct.2010,were reviewed.The general information,risk factors,clinical manifestations,auxiliary examinations,diagnostic errors,risk stratification and curative effect were analyzed.Results There were 33 male patients and 34 female patients,with a mean age of（53.2±15.1） years.The most common risk factor was recent surgery（25.4%）.Clinically,dyspnea was commonly seen（88.1%）.Auxiliary examinations： the positive rates of D-Dimer assay and CTPA were97.0% and 70.6%,respectively;ECT showed a high sensitivity.Misdiagnosis rate of the first visit was 55.2%.The effective power was 91.4%（32/35） for low-risk group;80.0%（4/5） for moderate-risk group,combined therapy with thrombolysis and anticoagulation,and 94.7%（18/19） for anticoagulation therapy alone;100% for high-risk group（5/5）.Conclusion Misdiagnosis rate in PE is high.An integrated consideration should be made in terms of risk factors,clinical manifestations and the result of preliminary examination,such as D-Dimer.Once a suspicious diagnosis has been made,CTPA and ECT should be conducted as soon as possible to confirm the diagnosis.For high-risk cases,if no contraindications,an early thrombolysis should be given;for low-and moderate-risk patients,anticoagulation therapy alone can get a good outcome.