70例肺栓塞临床特点及危险因素分析

Analysis of clinical characteristics and risk factors of 70 cases of pulmonary embolism

目的提高对肺栓塞的诊断率，降低误诊率。方法对70例肺栓塞患者的临床特点、理化检查、治疗手段及危险因素进行回顾性分析。结果70例患者中，最常见的症状为呼吸困难者占92．9％，D-二聚体〉500μg／L者占92．9％，动脉血氧分压〈80mmHg者占95．7％，行CT肺动脉造影检查提示肺动脉段以上充盈缺损或肺栓塞者占92．1％，为主要诊断方法；27例患者接受溶栓治疗，40例选择单纯抗凝治疗，3例因出血未行抗凝治疗，共24例行下腔静脉滤器植入术以预防再次肺栓塞的发生；治愈7例占10％（均为溶栓治疗），好转60例占85．7％；死亡3例占4．3％（均未行溶栓治疗）。结论肺栓塞临床表现复杂，理化检查多不具特异性，CT肺动脉造影为首选诊断方法，必要时行肺动脉造影检查，溶栓风险高，但治愈率高。

Objective To improve the diagnosis of pulmonary embolism rate, decrease the rate of misdiagnosis. Methods The clinical features of 70 cases of patients with pulmonary embolism, physical and chemical examination, treatment and risk factors were retrospectively analyzed. Results In 70 patients,the most common symptoms of dyspnea accounted for 92.9%, two D-dimer 〉500μg/L was 92.9%,partial pressure of oxygen in arterial blood〈80 mmHg was 95.7%, for CTPA examination showed that the pulmonary artery or filling defect or pulmonary embolism accounted for 92.1%, as the main method for the diagnosis of 27 cases. Patients received thrombolytic therapy, 40 cases of anticoagulant therapy,3 cases with hemorrhage without anticoagulant therapy, 24 cases of inferior vena cava filter to prevent pulmonary embolism occurs again. Cure 7 cases accounted for 10 % （all thrombolytic therapy）, 60 cases improved accounted for 85.7%. Three cases of death accounted for 4.3% （no thrombolytic therapy）. Conclusions The clinical manifestation of pulmonary embolism complicated, physical and chemical examination was not specific, CTPA is the preferred method for diagnosis of pulmonary artery angiography,if necessary,with high risk,but high cure rate.