晕厥症状在评价急性肺栓塞严重程度及危险分层中的意义

The significance of syncope symptom in the evaluation of severity and risk stratification in acute pulmonary embolism

目的探讨晕厥症状在急性肺栓塞（APE）严重程度和危险分层中的作用及晕厥症状与右心功能不全（RVD）间的关系。方法回顾性收集并筛选APE患者临床资料，最终人选127例病例，对其人院时生化指标、收缩压、心率、一般统计学资料、有否心功能不全、有否晕厥症状及患者30d死亡率等资料进行收集，将有晕厥病史患者划人晕厥组，无晕厥病史患者划入非晕厥组，比较组间指标差异是否具有统计学意义。将RVD作为因变量，观测指标及有否晕厥作为自变量，进行Logistics回归分析，筛选对RVD预测具有统计学意义的指标。结果晕厥组（n=34）和非晕厥组（n=93）组间肌钙蛋白I及RVD组间比较差异具有统计学意义（P〈0．05），组间30d死亡率比较差异无统计学意义；在Logistics回归分析模型中，心率、动脉肺泡氧分压差、肌钙蛋白I和脑钠肽前体是预测RVD的独立危险因素（P=0．026、0．001、0．008、0．000，P〈0．05），而晕厥不是预测RVD的危险因素（P=0．335）。结论在APE患者中，如合并晕厥症状，患者会有更高的概率合并肌钙蛋白升高和RVD，需要更加严密的监护。

Objective To explore the role of syncope symptom in the severity and risk stratifica- tion of acute pulmonary embolism patients, and the relationship between the syncope symptom and right ventricular dysfunction. Methods We had enrolled 127 patients in this study. Information of acute pul- monary embolism including demographics, baseline characteristics biomarkers whether merging with right ventricular dysfunction, whether merging with syncope symptom and the 30-day mortality were ret- rospectively collected. If merging with syncope symptom the patients were divided into syncope （ ＋ ） group otherwise divided into syncope （-） group. Statistical analysis were done between the groups. We took right ventricular dysfunction as the dependent variable and took observed data and whether with syncope symptom as independent variable for conducting a Logistics regression model to screen which index was an independent prognosis factor of right ventricular dysfunction. Results Between syncope （ ＋ ） group and syncope （-） group the differences of troponin I and right ventricular dysfunction were statistically significant （P 〈 0.05）, but there were no statistical significance in others including 30-day morality.In Logistic regression model alveolar arterial oxygen difference, troponin I and brain natriuretic peptide were independent prognosis risk factors for right ventricular dysfunction （P=0.026, 0.001, 0.008, 0.000, P 〈 0.05）. Syncope symptom was not statistically significant （P = 0.335）. Conclusion In acute pulmonary embolism patients if patients merge with syncope symptom patients bad a higher probability of elevated troponin I and right ventricular dysfunction and need more monitoring.