心肌梗死合并肺栓塞的临床分析

Clinical Analysis on Myocardial Infarction Complicated with Pulmonary Embolism

目的分析心肌梗死合并肺栓塞患者的临床参数,探讨该病发生、发展单危险因素和独立危险因素,以期提高临床治疗水平。方法选取2010年2月至2013年2月解放军第一○五医院收治的135例心肌梗死患者为研究对象,对其中合并肺栓塞的59例患者从临床表现、实验室检查等方面进行总结,分析此类患者的临床参数,探讨发生此类疾病的危险因素。结果心肌梗死合并肺栓塞患者临床症状以呼吸困难、胸痛等为主,而在临床体征上则以肺部湿啰音、下肢肿痛等为主;实验室检查以低氧血症,高碳酸血症,肺泡气-动脉血氧分压差值、血浆D-二聚体、心肌肌钙蛋白等升高为主。多因素Logistic回归分析结果显示:高龄(>65岁)、情绪激动、手术等创伤性操作、冠心病、高血压是心肌梗死合并肺栓塞的危险因素(P<0.05)。结论密切观察病情,早期对症处理是降低心肌梗死合并肺栓塞发生、疾病进展的关键。

Objective To analyze on the clinical parameters of patients with myocardial infarctioncomplicated with pulmonary embolism and explore the single and independent risk factors of the disease, in order to improve the level of clinical treatment. Methods A total of 135 cases of patients with myocardial infarction,including 59 cases of patients complicated with pulmonary embolism admitted in the 105th Hospital of PLA from Feb. 2010 to Feb. 2013 were selected as research objects, the clinical manifestations and laboratory tests results of the 59 cases of patients complicated with pulmonary embolism were summerized, in order to analyze on the risk factors of pulmonary embolism, and the clinical parameters of those patients were analyzed to explore the risk factors of these diseases. Results Clinical symptoms of patients with myocardial infarction complicated with pulmonary embolism mainly included dyspnea, chest pain, etc. , and the clinical signs mainly included pulmonary rales,lower extremity swelling, etc;laboratory tests results usually showed hypoxemia, hypercapnia disease, alveolar-arterial oxygen difference, plasma D-dimer, elevated cardiac troponin level, etc. Results of multivariate logistic regression analysis showed that ： senility （ 〉 65 years） , agitation, surgery and other invasive procedures, coronary heart disease, hypertension are the risk factors of myocardial infarction complicated with pulmonary embolism（ P 〈 0.05 ）. Conclusion Close observation and early symptomatic treatment are the key approaches to reduce the occurrence and progression of myocardial infarction complicated with pulmonary embolism.