非大面积肺栓塞患者抗凝治疗3个月疗效评价

Clinical evaluation of non-massive pulmonary embolism in treatment of anticoagulation for three months

目的评价肺栓塞（pulmonaryembolism，PE）患者抗凝治疗3个月的临床疗效，探讨PE抗凝治疗的疗程。方法研究对象为山西医科大学第一医院呼吸科2011年8月至2012年6月确诊的PE患者32例，观察其规范化抗凝治疗3个月的临床表现及辅助检查，并与发病时的情况进行对比。结果32例患者治疗前后呼吸困难分别为84．38％及37．50％，咳嗽为43．75％及6．25％，下肢肿胀为40．63％及9．38％，胸痛为28．13％及3．13％。30例心电图sI、QⅢ和（或）TⅢ阳性者治疗前后分别为43．33％及6．67％，非特异性sT-T异常者治疗前后分别为63．33％及20．00％。28例超声心动图检查治疗前后肺动脉高压分别为71．43％及25．00％，右室扩大分别为78．57％及64．29％。30例治疗前后下肢深静脉存在血栓分别为70．00％及30．00％。32例治疗前后螺旋CT肺动脉造影肺动脉内充盈缺损分别为87．50％及21．88％；14例治疗前后肺灌注缺损分别为71．43％及21．43％。右室扩大治疗前后差异无统计学意义（P〉0．05），其余各指标治疗前后差异均有统计学意义（P值均〈0．05）。结论规范化抗凝治疗3个月，PE患者的临床表现显著改善，螺旋CT肺动脉造影、肺通气／灌注扫描和（或）下肢静脉超声检查多数仍存在异常，应经过临床评估后决策是否继续抗凝治疗。

Objective To evaluate the clinical efficacy of anticoagulant therapy for three months in patients with pulmonary embolism （PE）, and to explore the course of anticoagulant therapy. Methods The subjects were 32 PE patients diagnosed in department of respiration medicine of the first hospital of shanxi medical university from August 2011 to June 2012. The clinical manifestation and auxiliary examination after anticoagulant therapy for three months were observed, and compared with those before treatment. Results Of the 32 patients, 84.38% and 37.50% had dyspnea, 43.75% and 6.25% had cough,40.63% and 9.38M had lower limb swelling,28.13% and 3.13% had chest pain before and after treatment. Of 30 eases,St , QIII and/or TIII were positive in 43.33% and 6.67% patients, 63.33% and 20.00% had nonspecific abnormal ST-T before and after treatment. Of 28 cases, eehocardiography examination showed that 71.43% and 25.00% had pulmonary arterial hypertension,78.57% and 64.29% had right ventrieular enlargement. 70.00% and 30.00% of 30 cases had lower extremity deep venous thrombosis before and after treatment. CTPA showed that 87.50% and 21.88% of 32 patients had pulmonary arteries filling, 71.43% and 21.43% of 14 cases had pulmonary perfusion before and after treatment. There was no significant difference in right ventrieular enlargement before and after treatment （ P 〈 0.05）, and there was statistical significance in other indexes before and after treatment （ P 0.05）. Conclusions Through the standardized antieoagulation therapy for three months, the clinical manifestations of PE patients are significantly improved, but CTPA, V/Q and/or DVT are abnormal in majority of patients, so the decision whether they should continue anticoagulation therapy should be made alter clinical evaluation.