海南省急性肺血栓栓塞症的流行病学特点及临床特征分析

Epidemiological characteristics and clinical features of acute pulmonary thromboembolism in Hainan Province

目的分析海南省急性肺血栓栓塞症(pulmonary thromboembolism,PTE)的流行病学特点及临床特征。方法收集2015年1月至2017年12月3年间所有本院确诊的急性PTE患者资料,分析其流行病学、危险因素、临床症状、辅助检查、治疗以及临床转归情况。结果共收治急性PTE 296例,其中男性184例,女性112例,男女比例1.64∶1。年龄26~87岁,60岁以上占71.3%。危险分层高危14.6%、中危30.0%、低危55.4%;栓塞面积分级大块面积栓塞20.0%、次大块面积栓塞32.8%、非大块面积栓塞47.2%。PTE在海南各地区均有发病,发病率无明显差别(P>0.01);各季节均有发病,以冬季多见,差异有统计学意义(P<0.01)。危险因素以深静脉血栓(DVT)最高66.5%。临床表现以呼吸困难为首发症状79%,以晕厥为首发症状11%,出现胸痛症状35%,出现咯血25%,同时出现三联征者19%,出现休克或低血压者14.5%。血气分析表现为低O2和(或)低CO2血症。心超提示肺动脉高压46.2%。超声提示63.1%合并下肢DVT,4.0%合并上肢DVT。心电图有SIQⅢTⅢ或SIQⅢ、电轴右偏和完全右束支传导阻滞等特征性表现者30.7%。均有D-二聚体升高。单纯抗凝治疗43.2%,介入碎栓溶栓治疗39.6%,系统性溶栓治疗17.2%。总好转率89.5%,总死亡率3.7%。复发12.5%,慢性血栓性肺动脉高压13.8%。结论急性PTE也是海南省的多发病,以DVT以及恶性肿瘤为主要危险因素。发病年龄跨度大,临床症状多样,隐蔽性强,初诊误诊率高,并发症多,死亡率高。提高各临床科室医护人员对于急性PTE的防控、诊断意识及治疗规范化程度,可以提高确诊率,降低病死率,减少并发症及复发率。

Objective To investigate the epidemiological characteristics and clinical characteristics of acute pulmonary thromboembolism （PTE） in Hainan Province. Methods From January 2015 to December 2017, the data of patients enrolled with diagnosis of acute PTE were collected and analyzed, including its epidemiology, risk factors, clinical symptoms and auxiliary examination, treatment and clinical outcomes. Results 296 cases of acute PTE were treated, including 184 males and 112 females between 26 and 87 years old, of whom 71.3% were over 60 years old. Risk stratification analysis indicated that the patients with high risk was 14.6%, the moderate 30.0%, and the low 55.4%. Embolization area grading analysis showed that the patients with large area is 20.0%, the secondary large area 32.8%, and non-large area 47.2%. No significant difference in PTE incidence was found in all geographical regions of Hainan（P〉0.01 ）. All seasons had onset, which was more common in winter with statistically significant （P〈0.01）. Deep vein thrombosis （DVT） account for 66.5% of the risk factors, and the rest factors included malignant tumors, trauma orsurgical history. The clinical manifestations included dyspnea （79%）, syncope （11%）, chest pain （35%） and hemoptysis （25%）. 19 percent of those had simultaneous ＂triple attacks＂. Shock or hypotension occurred in 14.5% of patients. Blood gas analysis showed low O2 and （or） low CO2. Cardiac ultrasound found 46.2% incidence of hyperbaric arterial hypertension. Ultrasound indicated 63.1% of the lower limb DVT and 4.0% of the upper limb DVT. Electrocardiogram showed SIQⅢTⅢ or SIQⅢ , 30.7% patients had electric axis right and complete right bundle branch block characteristic. All showed D-dimer increases. 39.6% patients was treated with thrombolytic therapy, and 17.2% systemic thrombolytic therapy. The total conversion rate was 89.5% and the total mortality rate was 3.7%, and relapse rate was 12.5%, chronic thrombotic pulmonary hypertension 13.8%. Conclusions Acute PTE is endemic in Hainan. DVT and malignant tumor were the main risk factors. The onset age span was large, the clinical symptoms was diverse. Acute PTE had high concealment rate, the misdiagnosis rate was high with much complications and high mortality. Strengthening prevention/control and standardilized treatment of acute PTE, can effectively improve the diagnosis rate, reducing the case fatality rate and complications / recurrence rate.