恶性肿瘤并发肺栓塞44例临床分析

An analysis of 44 malignant tumor cases with pulmonary embolism

目的探讨恶性肿瘤患者发生肺栓塞的危险因素及临床特征。方法回顾性分析44例恶性肿瘤并发肺栓塞患者的临床资料。结果44例患者中，同时发生胸痛、呼吸困难和咯血者2例（4．55％），以呼吸困难为首发症状19例（43．18％）；常规作胸部增强CT时偶然发现肺栓塞8例（18．18％），术后1个月内发生肺栓塞18例（40．91％），化疗后1个月内发生肺栓塞11例（25．00％）。根据Geneva量表评分标准进行评分：O～3分9例（20．45％），4～10分25例（56．82％），≥11分10例（22．73％）。检测D-二聚体水平的35例患者中，D-二聚体升高18例（51．43％），D-二聚体正常17例（48．57％）。37例患者经正规抗凝溶栓治疗后临床症状缓解；7例患者因原发肿瘤死亡。结论恶性肿瘤患者是发生肺栓塞事件的高危人群，早期诊断和治疗可以有效改善患者预后。

Objective To analyze the risk factors and clinical characteristics of pulmonary embolism in the patients with malignant tumors. Methods The clinical data of 44 malignant tumor patients with pulmonary embolism were retrospectively analyzed. Results Of 44 cases, pulmonary embolism with clinical symptoms of thoracodynia, dyspnea and hemoptysis was in 2 cases（4. 55 % ） and initial symptom of dyspnea was in 19 cases（43.18%）. Pulmonary embolism was accidentally found in 8 cases（18. 18%） when the malignant tumor was diagnosed by enhanced CT, while it occurred in 18 cases（40.91%） within one month after surgery and 11 cases （25.00%） within one month after chemotherapy. Based on the standards of Geneva scale, the scores were 0-3 points in 9 cases （20.45%）,4-10 points in 25 cases（56.82%） and ≥11 points in 10 cases（22. 73%）. Of 35 cases accepted the detection of D-dimer, the level of D-dimer was increased in 18 cases（51.43%） and normal in 17 cases（48. 57%）. The clinical symptoms of 37 patients were relieved after anticoagulation and fibrinolysis therapy,and 7 patients died of primary tumors. Conclusion The patients with malignant tumors are the high-risk population of pulmonary embolism. Early diagnosis and treatment can effectively improve the prognosis of patients.