急性肺栓塞45例临床诊治分析

Clinical analysis of 45 cases of acute pulmonary embolism

目的总结探讨急性肺栓塞的易患因素、临床表现以及诊治方法,以提高对急性肺栓塞的认识。方法回顾性分析蚌埠市第一人民医院2010年1月—2016年12月45例临床诊断急性肺栓塞患者的易患因素、临床表现、诊治方法及转归。结果临床诊断急性肺栓塞45例患者中,男性23例,女性22例,患者年龄34~88岁,平均年龄(69.00±12.79)岁,其中内科患者36例,占80%,外科患者9例,占20%。临床表现为胸闷38例,气促20例,休克12例,咳嗽10例,呼吸困难10例,胸痛7例,心悸8例,咯血2例,晕厥1例,30例以上同时有2个以上上述症状。危险因素依次为下肢静脉血栓或下肢静脉曲张、心脑血管疾病、骨折或骨折手术、吸烟、卧床超过3 d、糖尿病及慢性阻塞性肺病史。本组患者中,通过CT肺动脉造影(CTPA)确诊39例,均为肺血栓栓塞症,心脏彩超确诊1例,通过手术取栓确诊1例,病情危重通过临床综合分析讨论诊断4例。D-二聚体阳性率达93%,心电图、心脏彩超、下肢静脉彩超及血气分析均有一定特异性改变。6例因抢救无效死亡,1例取栓术后昏迷不醒家属放弃治疗,其余进行了溶栓或抗凝治疗,临床症状都有了明显改善。结论急性肺栓塞缺乏特异性的症状和体征,发病率与易患因素密切相关,溶栓与抗凝治疗可提高急性肺栓塞患者的生存率。

Objective To discuss and summarize the predisposing factors, clinical features and treatment methods of acute pulmonary embolism, thus to improve the understanding of acute pulmonary embolism. Methods The predisposing factors, clinical manifestations, diagnosis, treatment and prognosis of 45 cases diagnosed as acute pulmonary embolism were analyzed retrospectively from January, 2010 to December, 2016 in the first people＇ s hospital of Bengbu. Results The clinical diagnosis of acute pulmonary embolism in 45 patients included 23 cases of male ,22 cases of female. The age of the patients ranged from 34 to 88 years, with an average age of （ 69.00 ±12.79 ） years, including 36 cases of internal medicine （ 80% ） , surgical patients in 9 cases （ 20% ）. The clinical manifestations were chest tightness （ n = 38 ） , anhelation （ n = 20 ）, shock （ n = 12 ）, cough （ n = 10 ）, dyspnea （ n = 10 ）, chest pain （ n = 7 ）, palpitations （ n = 7 ）, hemoptysis （ n = 2 ）, and syncope （ n = 1 ）. Thirty cases had more than 2 symptoms at the same time. The risk factors were as follows ： venous thrombosis of lower limbs or lower extremity varicose veins, cardiovascular and cerebrovascular diseases, fracture or fracture surgery, smoking, staying in bed for more than 3 days, diabetes and chronic obstructive pulmonary disease. In this group of patients ,39 cases were diagnosed by CTPA as pulmonary thromboembolism, 1 case was diagnosed by echocardiography, 1 case was diagnosed by surgical thrombectomy, and 4 critical condition cases were diagnosed by clinical comprehensive analysis. The positive rate of D-dimer was 93%. Electrocardiogram, echocardiography, lower limb venous ultrasonography and blood gas analysis had certain specific changes. Six cases died due to invalid rescue, one case was treated with thrombolytic therapy remain unconscious, the others were treated with thrombolytic or anticoagulant therapy, and the clinical symptoms were improved obviously. Conclusion Acute pulmonary embolism lacks specific symptoms and signs. Incidence of the disease is closely related to the susceptible factors. Thrombolysis and antieoagulation therapy can improve the survival rate in patients with acute pulmonary embolism.