肺血栓栓塞症60例分析

Analysis of 60 patients with pulmonary thromboembolism

目的了解肺血栓栓塞症(PTE)的临床特点。方法选取60例经计算机断层摄影肺血管造影(CTPA)确诊的PTE患者,回顾性分析患者的危险因素、临床表现和辅助检查结果。结果 60例患者中男31例(51.67%),女29例(48.33%)。60例患者中<40岁10例(16.67%),40~60岁23例(38.33%),>60岁27例(45.00%)。60例患者的体质量指数(22.82±3.84)kg/m^2,消瘦10例(16.67%),正常28例(46.67%),超重17例(28.33%),肥胖5例(8.33%)。60例患者中呼吸困难最多(占68.33%),胸痛次之(占40.00%),仅有1例(1.67%)表现为典型的胸痛、咯血、呼吸困难三联征。心动过速23例(38.33%),呼吸急促9例(15.00%),肺部啰音21例(35.00%),P2亢进11例(18.33%)。低氧血症37例(61.67%),D-二聚体阳性47例(78.33%),阴性13例(21.67%),血浆纤维蛋白原(FIB)升高23例(46.67%),心电图表现为SIQⅢTⅢ18例(30.00%),肺型P波0例(0),右束支传导阻滞4例(6.67%),ST-T改变20例(33.33%),下肢静脉彩超深静脉血栓形成(DVT)阳性32例(53.33%),心脏彩超提示肺动脉高压23例(38.33%)。结论大多数PTE患者的临床表现不典型,PTE临床因素、常规血液学检查及心电图、心脏彩超等检查有提示意义,早期行CTPA检查有利于风险排除。

Objective To understand the clinical characteristics of pulmonary thromboembolism（PTE）. Methods A total of 60 patients with PTE confirmed by computed tomography pulmonary angiography（CTPA）.The risk factors, clinical presentation and results of auxiliary examinations were retrospectively analyzed. Results In 60 patients, 31 cases（51.67%） were maleand 29 cases（48.33%） were female. Among the 60 patients, 10 cases（16.67%） were younger than 40 years old, 23 cases（38.33%） were 40-60 years old, 27 cases（45.00%） were 60 years old. The body mass index of patients was（22.82±3.84）kg/m-2, 10 cases（16.67%） were emaciated, 17 cases（28.33%） were overweight, and 5 cases（8.33%） were obese. Among all patients, dyspnea was the most common（68.33%）, chest pain was the second（40.00%）, and only 1（1.67%） showed typical chest pain, hemoptysis and dyspnea triad. Tachycardia in 23 cases（38.33%）, shortness of breath in 9 cases（15.00%）, and pulmonary rales in 21 cases（35.00%）, hyperactivity of P2 in 11 cases（18.33%）. Hypoxemia was found in 37 cases（61.67%）, D-two polymers were positive in 47 cases（78.33%）, negative in 13 cases（21.67%）, and plasma fibrinogen（FIB） increased in 23 cases（46.67%）. ECG showed SIQⅢTⅢ in 18 cases（30.00%）, there was no pulmonary P wave case, right bundle branch block in 4 cases（6.67%）. ST-T changes in 20 cases（33.33%）, deep vein thrombosis（DVT） in 32 cases（53.33%）, 23 cases（38.33%） of pulmonary hypertension were revealed by cardiac color Doppler ultrasound. Conclusion Most PTE patients have no typical clinical presentation, PTE clinical factors, routine hematological examination, electrocardiogram, cardiac color ultrasound and other examinations have implications, and early CTPA inspection is beneficial to risk exclusion.