肺血栓栓塞症28例临床特征分析

Analysis on Clinical Features of 28 Patients with Pulmonary Thromboembolism

【目的】探讨肺血栓栓塞症（PTE）的临床诊治特点，为临床治疗提供依据。【方法】选取本院收治的28例PTE患者病例资料，对其临床诊断、治疗情况及危险因素进行回顾性分析。【结果】患者中有高血压痛者12例（42．9％）、糖尿病者3例（10：7％）、冠心病者3例（10．7％）、肿瘤术后4例（14．3％）、下肢骨折者7例（25％）、脑血管意外者2例（7．1％）、慢性阻塞性肺病者2例（7．1％）。本组中患者多以呼吸困难、呼吸增快、胸痛、咯血、咳嗽、发热、心悸、心动过速、紫绀、下肢不对称水肿为主要特征。经过规范溶栓或抗凝治疗，症状均有不同程度改善。【结论]PTE临床表现无明显特异性，易误诊、漏诊；螺旋CT肺血管造影是诊断PTE的可靠方法，其特点是简便、快速、无创；及时规范的溶栓抗凝疗法在急性PTE的治疗中疗效肯定。

[Objective]To explore the clinical characteristics of diagnosis and treatment of pulmonary thromboembolism（PTE） in order to provide the evidence for clinical treatment. [Methods]The case data of 28 PTE patients admitted to our hospital were chosen. Clinical diagnosis, treatment and risk factors were ana- lyzed retrospectively. [Results]There were 12 patients with hypertension（42.9~）, 3 patients with diabetes mellitus（10.7%）, 3 patients with coronary heart disease（10.7%）, 4 patients after tumor operation（14.3%）, 7 patients with lower limb fracture（25 %）, 2 patients with cerebral vascular accident （7.1~） and 2 patients with chronic obstructive pulmonary disease（7.1%）. The main features of patients were dyspnea, fast breath- ing, chest pain, hemoptysis, cough, fever, heart palpitations, tachycardia, cyanosis and asymmetric edema of lower limbs. After standard thrombolytic or anticoagulant therapy, the symptoms had different degrees of im- provement. [Conclusion] Clinical manifestations of PTE show no obvious specificity. PTE is easy to be misdi- agnosed and miss diagnosis. Spiral CT pulmonary artery angiography（CTPA ） is a reliable method for the di- agnosis of PTE, and is simple, rapid and noninvasive. Timely thromb01ytic and anticoagulant therapy for acute PTE is effective.