急性肺血栓栓塞症94例临床分析

Clinical analysis of 94 cases with acute pulmonary thromboembolism

目的加强对急性肺血栓栓塞症（pulmonary thromboembolism,PTE）高危因素、临床表现和不同危险程度的PTE患者治疗疗效的认识。方法收集本院2006年12月至2014年12月诊治的94例PTE患者完整临床资料,根据入院时的临床表现分为高危组和非高危组两组,比较常见危险因素、临床表现、治疗手段与疗效的差异。结果 PTE患者高危因素前3位依次为心脑血管疾病[高血压（54.3%）、冠心病（36.2%）、糖尿病（31.9%）、脑梗死（20.2%）]、下肢静脉血栓病史（54.3%）、手术或骨折制动（31.9%）。呼吸困难（76.6%）、胸痛（37.8%）为PTE常见症状,呼吸频率增快（53.2%）是最常见的体征;比较高危组和非高危组的疗效,差异有显著性（χ^2=21.467,P〈0.05）;溶栓组和抗凝组的疗效比较,差异有显著性（χ^2=17.370,P=0.001）,而出血风险差异无显著性（χ^2=0.591,P=0.442）。结论重视PTE患者高危因素、临床表现有助于提高临床PTE确诊率,而抗凝和溶栓治疗则影响患者短期预后。

Objective To enhance the understanding of risk factors, clinical manifestations and different efficacy in pulmonary thromboembolism（PTE） patients with different risk stratification. Method 94 PTE cases of with complete clinical data entered in our hospital from December 2006 to December 2014 were involved into this study, which were divided into 2 groups： high-risk group and nonhigh risk group. The common risk factors, clinical manifestations, treatment and curative effect of the two groups were analyzed. Result The most common risk factors of PTE patients are cardiovascular and cerebrovascular diseases（hypertension 54.3%, coronary heart disease 36.2%, diabetes 31.9%, cerebral infarction 20.2%）, history of lower extremity deep venous thrombosis（54.3%）, operation or fracture brake（31.9%）. Dyspnea（76.6%） and chest pain（37.8%） are the most common clinical symptoms. The increased respiratory frequency（53.2%） is the most common signs. As for the efficacy, it is much better in non-high risk group compared with the high risk group（χ^2=21.467, P0.05）; the efficacy of thrombolysis is better than that of anticoagulation（χ^2=17.370, P=0.001）, and no difference was found in the risk of bleeding（χ^2=0.591, P=0.442）. Conclusion Paying much attention to the high risk factors and common clinical manifestations of PTE patients may improve the clinical diagnostic rate of PTE. Non-high risk group therapy effect is better than that of high risk group.