院内突发急性肺栓塞的临床诊治分析

The analysis of diagnosis and treatment of acute pulmonary embolism outbreak in hospital

目的分析院内突发急性肺栓塞(acute pulmonary embolism,APE)的临床特点,总结救治经验。方法系统回顾分析2002～2011年因其他疾病入院并于住院期间突发APE的44例患者临床资料。结果纳入该研究的病例共44例,其中32例经救治痊愈,12例死亡。痊愈组和死亡组年龄(t=1.07,P>0.05)和性别(χ2=0.08,P>0.05)均无统计学差异;两组患者入院时疾病类别(χ2=2.06,P>0.05)无统计学差异;院内突发APE患者临床症状多不典型,常表现为突然意识丧失、血压下降等,ECG、CT、D-二聚体等具有重要诊断价值,但尚不能据此判断患者预后;痊愈组患者均在发病1小时后才确诊并予抗凝、溶栓等治疗,死亡组患者除1例在1小时死亡外,余皆在发病后半小时左右死亡,未及抗凝、溶栓等治疗。结论年龄、性别及入院时疾病均不是院内突发APE患者死亡的关键因素,辅助诊断在帮助诊断APE时具有重要参考价值,但对判断患者预后价值不大,猝死可能是患者肺栓塞面积过大造成的,需进一步研究证实。

Objective： To evaluate clinical features of acute pulmonary embolism （APE） outbreak in hospital and try to find how to eflqciently treat APE. Methods： The clinical data of 44 patients who were treated in the second hospital of Jining between the year 2002 and 2011 and had APE attack in hospital were systematically and retrospectively analyzed. Results： Forty- four patients with APE were included in the research. Among them, 32 patients recovered and 12 patients died. There was no significant difference between patients who recovered and those who died in age （ t = 1. 07, P 〉 0.05 ） and gender （X2 = 0. 08, P 〉 0.05 ）. There was no significant difference between the 2 groups in disease composition of patients （X2 = 2. 06, P 〉 0.05 ） at admission in hospital. Most of these patients had atypical clinical symptoms, such as loss of con- sciousness and hypotension. The prognosis of the disease eould not be judged by ECG, CT and D-dimmers, although they were important in the diagnosis of the disease. The patients who recovered were treated with anticoagulant and thrombolytic therapy when they were diagnosed 1 hour after outbreak of the disease. Eleven patients died half an hour and 1 patient died 1 hour after the outbreak without anticoagulant and thrombolytic therapy for there was no enough time to make a diagnosis. Conclusion： The patients dont die of age, gender and diseases at admission in hospital. The prognosis of APE can not be judged by laboratory diagnosis although they are important in the diagnosis of the disease. The sudden death of patients with APE may be eansed by large thrombosis, which needs to be studied further.