中危急性肺栓塞临床特征及治疗分析

Clinical features and treatment analysis of moderately critical acute pulmonary embolism

目的探讨中危急性肺血栓栓塞的临床表现及治疗。方法回顾性分析我院2014年1月1日~2015年12月31日间诊治的142例中危急性肺栓塞病例的临床资料,观察治疗后肺动脉收缩压下降情况;计算56例中高危患者溶栓及单纯抗凝治疗有效率及出血发生情况。结果中危急性肺栓塞临床更多表现为呼吸困难、咳嗽及晕厥;中高危56例中16例行溶栓治疗,余40例及86例中低危行单纯抗凝治疗;中高危患者溶栓组及抗凝组分别死亡1例和2例;中高危和中低危抗凝治疗分别有1例发生持续肺动脉高压,有效率分别为93.75%(15/16)和92.50%(37/40)(P>0.05);两组出血分别3例和5例,差异无统计学意义(P>0.05)。结论中危肺栓塞治疗存在较大挑战,需要临床更多的动态评估,选择个体化的治疗,改善预后。

Objective To investigate the clinical manifestations and treatment of moderately critical acute pulmonary embolism. Methods The clinical data of 142 patients with moderately critical acute pulmonary embolism who were diagnosed and treated in our hospital from January 1, 2014 to December 31, 2015 were retrospectively analyzed, and decreased pulmonary arterial systolic pressure was observed after the treatment; the effective rate of thrombolysis and anticoagulant therapy alone in 56 cases of highly and moderately critical patients and the incidence of bleeding were calculated. Results The clinical manifestations in the patients with moderately critical acute pulmonary embolism were dyspnea, cough and fainting; among the 56 highly and moderately critical patients, 16 patients received thrombolysis,and the remaining 40 patients and 86 patients with moderate low risk were treated with anticoagulation therapy alone; 1 case and 2 cases were deceased in thrombolysis group and anticoagulation group; only one case had persistent pulmonary hypertension for the highly and moderately critical patients and moderately and lowly critical patients receiving anticoagulation therapy, and the effective rate was 93.75%（15/16） and 92.50%（37/40）（P〉0.05）; there were 3 cases and5 cases of bleeding in both groups,the difference was statistically significant（P〉0.05）. Conclusion There is a big challenge in the treatment of moderately critical pulmonary embolism, which requires more dynamic assessment in clinical practice. Individualized treatment should be selected to improve prognosis.