急性心肌梗死合并急性肺血栓栓塞症34例临床分析及长期随访

Clinical analysis and long-term follow-up of 34 acute myocardial infarction patients complicated with acute pulmonary thromboembolism

目的分析急性心肌梗死(acute myocardial infarction,AMI)合并急性肺血栓栓塞症(acute pulmonary thromboembolism,APTE)的临床资料和长期随访结果,讨论该病发生的危险因素,评价抗栓药物的疗效及患者预后。方法回顾性分析2004年3月至2014年5月阜外心血管病医院确诊的34例AMI合并APTE患者的临床资料,对其进行电话随访,并行Kaplan-Meier生存分析。结果患者年龄≥60岁、高血压病、糖尿病、高脂血症、冠心病史、长期卧床的比例较高,以胸闷、呼吸困难、胸痛、大汗等表现为主,临床体征以肺部湿啰音为主,主要通过肺动脉CT增强扫描确诊。阿司匹林+氯吡格雷+华法林(三联抗栓)组出血率较高,但均为非致命性出血,无血栓事件发生,与其他组比较,相对安全、有效。患者总死亡率为20.6%,预后差。结论 AMI合并APTE患者多合并多个危险因素,临床预后差,胸闷、胸痛、呼吸困难、大汗症状突出,主要通过肺血管CT增强扫描明确诊断,三联抗栓治疗是相对安全有效的。

Objective To analyze the clinical data and long-term follow-up of patients with acute myocardial infarction complicated with acute pulmonary thromboembolism, in order to explore the risk factors of the disease, estimate the outcomes of different antithrombotic drugs and evaluate the prognosis of patients. Methods A total of 34 patients with acute myocardial infarction complicated with acute pulmonary thromboembolism from March 2004 to May 2014 in Fuwai Hospital were studied. Their clinical parameters were analyzed and they were followed up by telephone. Survivals were analyzed by Kaplan-Meier method. Results The rates of age older than 60 years old （ 64. 7% ） , comorbid with hypertension （ 61.8% ）, diabetes mellitus （ 44. 1% ） , hyperlipidemia （ 38.2% ） , coronary heart disease （ 32.4% ） and being bedridden （32.4%） are relatively high in these patients. The clinical presenting symptoms mainly included chest distress, dyspnea, chest pain and diaphoresis. The clinical signs mainly included pulmonary tales. The diagnosis of pulmonary thromboembolism were mainly made by spiral computed tomography. Higher bleeding rate was observed in patients received triple antithrombotic therapy （aspirin, clopidogrel and warfarin） , but all the bleeding events belonged to nonfatal major bleeding, while no thromboembolic events occurred in this group. The overall mortality rate was 20. 6%. Conclusions Patients with acute myocardial infarction complicated with acute pulmonary thromboembolism often had many risk factors and poor prognosis, most common presentations included chest distress, dyspnea, chest pain and diaphoresis, and its diagnosis was mostly confirmed by spiral computed tomography. Triple antithrombotic therapy was relatively safe and effective.