及时诊断和溶栓抗凝治疗对肺血栓栓塞疗效的影响

The impact of early diagnosis and thrombolytic-anticoagulant therapies on outcome of pulmonary embolism

目的 探讨及时诊断和溶栓抗凝治疗对肺血栓栓塞 (PTE)疗效的影响。方法 回顾性分析了 46例PTE患者的临床诊断和溶栓抗凝治疗 ,并以诊断时间是否超过 2周为界 ,观察其疗效。结果 46例患者均有基础疾病 ,其中 ,合并下肢深静脉血栓者 33例 (71 7% ) ,有心肺疾患者 2 3例(5 0 % ) ,外科手术后 6例 (13% )。有 36例患者经放射性核素肺通气和灌注扫描确诊。有 13例患者误诊为心肺疾病 ,误诊率为 2 8 3 %。诊断时间在 2周以内的患者经溶栓抗凝治疗后总有效率为 93 1% ,超过 2周的患者总有效率为 5 2 9% ,差异有显著性 (P <0 0 1)。结论 诊断时间在 2周内疗效显著 ,超过 2周 ,也有一定的效果。

Objective To investigate the effect of early diagnosis and thrombolytic followed by anticoagulant therapy in pulmonary embolism(PE). Methods 46 patients diagnosed as PE were restrospetively analyzed. All the patients were treated with thrombolytic followed by anticoagulant therapy.Therapeutic effect was compared between two groups of patients with symptoms more or less than two weeks before establishment of diagnosis. Result 36 patients were documented as PE by lung scan, 13 of 46 patients (28.3%) were misdiagnosed as other heart or lung diseases. All the patients had accompanying diseases, including leg deep vein thrombosis (DVT)(33/46,71.7%) heart or lung diseases other than PE(23/46,50%), and history of surgery (6/46,3%).93.1% of the patients with clinical history less than 2 weeks showed improvement, whereas only 52 9% of those with clinical history exceeding 2 weeks improved. There was significant difference between them. Conclusion In order to diagnose PE early, we should pay more attention to the risk factors of PE, especially DVT. The success of thrombolysis appears to depend on the interval between the onset of symptoms and start of thrombolytic therapy.Patients with clinical symptoms less than 2 weeks show better improvement.