老年与非老年肺血栓栓塞症患者临床特征分析

Analysis of clinical features of pulmonary thromboembolism in old and non-old patients

目的分析探讨肺血栓栓塞症(PTE)患者临床特征,并比较不同年龄段PTE患者的临床特点。方法回顾性分析明确诊断的42例PTE患者,按年龄分为老年组(≥60岁)24例和非老年组(<60岁)18例,对两组患者的危险因素、临床表现、实验室及物理检查等资料进行对比分析。结果 PTE患者常见危险因素及基础疾病依次是高血压病、长期卧床或制动、近期手术、既往深静脉血栓形成(DVT)史,最常见症状、体征分别为胸闷、呼吸急促。与非老年组相比,老年组患者合并基础疾病多,胸痛、咯血及典型三联征比例低,D-二聚体水平升高,两组间差异有统计学意义(P<0.05)。PTE患者最常累及血管为左下叶肺动脉、右下叶肺动脉,老年组与非老年相比差异无统计学意义(P>0.05)。结论老年PTE患者基础疾病多、临床表现不典型,临床易漏诊、误诊;非老年患者因缺乏危险因素及基础疾病,临床首诊易忽视,临床诊断中应引起足够重视。

Objective To explore the clinical characteristics of acute pulmonary thromboembolism （ PTE ）, and compare the clinical feature of between old and non-old patients. Methods The clinical data were reviewed for 42 patients with confirmed PTE. The risk factors, clinical symptoms, laboratory and imaging data of acute FFE in 24 older patients （ ≥60 ages） and 18 younger patients （ 〈60 ages） were retrospectively analyzed. Results Risk factors in both groups were primary hypertension, immobilization, surgery, history of DVT. The most frequent symptom was oppression in chest and the frequent physical sign was tachypnea. Compared with the younger group, comorbidity and primary hypertension occurred more often in the older group, whereas chest pain, haemoptysis and three clinical syndromes were less frequent（P 〈 0. 05 ）. The level of D-dimer in the older group was obviously higher than that in the younger group （P 〈 0.05 ）. The PTE patients involved lower left pulmonary artery and right pul- monary more often than other artery blood vessels in both groups, and there was no significant difference in the two groups （ P 〉 0.05 ）. Conclusion The clinical presentation of pulmonary embolism can be subtle or atypical in elderly patients, who usually have more eomorbidities. Clinical first option for PTE of non-old patients is easy to ignore because of lack of risk factors.