住院肺血栓栓塞症患者15年诊治情况的变迁

Trends of diagnosis and management of pulmonary thromboembolism in hospitalized patients in the last fifteen years

目的 了解住院肺血栓栓塞症 (PTE)患者临床流行病学特征及诊治变迁 ;探讨影响PTE临床病程的危险因素。为今后PE的防治工作提供参考依据。方法 将 1985年 1月～ 1999年 12月(15年间 ) ,因肺栓塞住院或入院后发现、发生肺栓塞的 149例患者的临床资料进行分析。各组数据经统计学处理。结果 1995～ 1999年肺栓塞年平均住院人数较 1994年前增长 4倍 ,病死率由 42 0 %降至 9 0 %。确诊手段、治疗方法逐年完善。院内外误诊率、漏诊率为 5 7 7%。男性PTE发病年龄早于女性约 2 0年 ,有统计学意义 (P <0 0 5 )。心脏血管介入性操作占有诱发因素患者的 13 4%。结论 肺栓塞住院人数呈上升趋势 ,病死率下降。临床误诊率、漏诊率仍较高。心脏血管介入性操作有可能为诱发因素之一。女性PTE发病年龄高峰迟于男性 ,是否与雌激素水平周期性变化导致凝血机制改变有关 ,有待研究。PE转归与医疗干预技能密切相关。

Objective To assess the accuracy of diagnosis and efficacy of management of pulmonary thromboembolism (PTE) and the related risk factors in hospitalized patients. Methods The clinical data of 149 inpatients with PTE admitted to Anzhen hospital from Jan 1985 to Dec 1999 were reviewed. The clinical epidemiological profile including approaches of diagnosis and treatment and prognosis in three different time intervals (1985～1989,1990～1994,1995～1999) were compared.Results There was a four time increases of the annual admitted PTE cases in 1995～1999 period as compared with the former two periods. Mortality fell from 42.0% to 9.0%. In the first period (1985～1989) 83.3% of patients were diagnosed based on clinical symptoms only and 4.2% on ECT, as compared with 75.0% on ECT, 15% on catheterization and only 7.8% on simply clinical symptoms in the last period (1994～1999). False or misdiagnosis rate was 57.7% in those patients on admission. Male Patients <40yrs were significantly more than female ( P <0.05). Cardiovascular intervention operation may be an important risk factor inducing PTE. Conclusion There was an increasing trend of diagnosis PTE in inpatients. Owing to the improvement of diagnosis, mortality significantly decreased in the last ten years.