78例肺栓塞的临床特征与诊治

Clinical characteristics and treatment of 78 patients with pulmonary embolism

目的回顾分析78例肺栓塞病例的临床资料,探讨《急性肺栓塞诊断与治疗中国专家共识(2015)》用于指导肺栓塞临床实践的价值以及注意事项。方法按照《急性肺栓塞诊断与治疗中国专家共识(2015)》的建议,收集2009年1月至2016年3月在我院确诊为肺栓塞的78例病例的易患因素、临床表现、诊断以及治疗方面的信息。结果 72例(92%)患者有肺栓塞易患因素。主要的临床表现为呼吸困难(73%)、胸痛(28%)、咳嗽(24%)、发热(6%)、咯血(3%)、晕厥及晕厥先兆(19%)、单侧肢体疼痛(6%)、单侧肢体肿胀(22%)。辅助检查提示D二聚体增高(96%)、心房利钠肽增高(75%)、心肌钙蛋白增高(61%),超声心动图提示右心负荷增加(53%)。心电图检查示窦性心动过速(46%),I导联S波(47%),右束支传导阻滞或V1~V4T波倒置(39%)。59%病例Wells评分≥2分,50%的病例Geneva评分≥3分,提示可能有肺栓塞。67例患者使用了口服抗凝药治疗,16例患者进行了溶栓治疗。结论肺栓塞的诊疗尚需按照《急性肺栓塞诊断与治疗中国专家共识(2015)》进一步的规范。

Objective To retrospectively analyze the clinical data of 78 patients with pulmonary embolism in order to explore the clinical practice value and notes of ＂Chinese expert consensus of diagnosis and treatment of acute pulmonary embolism in 2015＂. Methods We collected the data about susceptible factors ,clinical manifestation ,diagnosis and treatment from 78 patients with pulmo-nary embolism who were diagnosed in our hospital between January 2009 and March 2016 according to suggestions of the expert consen-sus.Results Seventy-two patients （92%） had risk factors for pulmonary embolism .The main clinical manifestations were dyspnea （73%）,chest pain （28%）,cough （24%）,fever （6%）,hemoptysis （3%）,syncope and presyncope （19%）,unilateral limb pain＆nbsp;（6%）,and single limb swelling （22%）.Laboratory tests showed elevated D-dimer （96%）,BNP （75%） and cardiac troponin （61%）.Echocardiogram showed an increase of right heart load （53%）.ECG showed sinus tachycardia （46%）,SⅠ（47%）,and right bundle branch block or V1 ~V4 T wave inversion （39%）.There were 59%of cases with the Wells score ≥2 points and 50%of ca-ses with Geneva score ≥3 points,suggesting pulmonary embolism .There were 67 patients treated with oral anticoagulant therapy and 16 patients undergone thrombolytic therapy .Conclusion The diagnosis and treatment of pulmonary embolism need to follow ＂Chinese ex-pert consensus of diagnosis and treatment of acute pulmonary embolism in 2015＂ for further improvements .