急性肺栓塞晕厥和不良预后关系的研究

Association between syncope and adverse prognosis in patients with acute pulmonary embolism

目的探讨临床急性肺栓塞患者发生晕厥的临床特点,分析晕厥与急性肺栓塞危险分层及住院死亡率的关系。方法回顾性选取2012年1月至2017年10月于中国医科大学附属盛京医院确诊的401例急性肺栓塞患者,根据有无晕厥分为晕厥组(58例)和无晕厥组(343例)。分析两组患者的基线临床资料、治疗情况及住院期间死亡率,并行单因素和多因素logistic回归分析,探讨晕厥与急性肺栓塞危险分层的关系。结果 401例急性肺栓塞患者中,男性196例,女性205例,年龄15～89岁,平均(58. 5±15. 6)岁。晕厥组与无晕厥组间低血压、心率> 100次/min、肌钙蛋白>0. 04μg/L、B型利钠肽> 100 pg/ml、肺动脉主干或左右肺动脉干栓塞、右心室大、中重度肺动脉高压、下肢静脉扩张及接受溶栓治疗等差异有统计学意义(均为P <0. 05)。晕厥组与无晕厥组住院期间的死亡率差异无统计学意义(5. 2%比5. 7%,P> 0. 05)。多因素logistic回归分析发现,低血压、肌钙蛋白升高、中重度肺动脉高压及肺动脉主干或左右肺动脉干栓塞均为晕厥发生的独立危险因素(均为P <0. 05)。将年龄、性别、咯血、心率> 100次/min、下肢静脉血栓、下肢静脉扩张、中性粒细胞比例及D-二聚体等放入回归方程时,晕厥是中高危及高危的急性肺栓塞的独立危险因素(P <0. 05)。结论急性肺栓塞伴发晕厥的患者多有肺动脉主干或左右肺动脉干栓塞、中重度肺动脉高压,多出现低血压及肌钙蛋白升高。晕厥可能与中高危及高危急性肺动脉栓塞有关,但晕厥与住院死亡率无明显相关。

Objective To investigate the clinical features of syncope in patients with acute pulmonary embolism(APE), and to analyze the relationship between syncope and risk stratification of acute pulmonary embolism and in-hospital mortality. Methods A retrospective study of 401 patients who were diagnosed with APE from January 2012 to October 2017 in our hospital. They were divided into two groups: patients who presented with syncope (n=58) and those without syncope (n=343). The clinical data, treatment and in-hospital mortality of two groups were analyzed by single factor analysis and multivariate Logistics regression analysis. Results Among 401 subjects with APE, there were 196 males and 205 females, aged 15 to 89 years, with an average age of (58.5±15.6) years. There were significant differences in admission systolic blood pressure <90 mmHg, heart rate >100 bmp/min, troponin Ⅰ>0.04 μg/L, brain natriuretic peptide>100 pg/ml, right ventricular dilation, moderate to severe pulmonary hypertension, pulmonary artery trunk and/or right and/or left main pulmonary artery embolism, lower extremity venous dilatation and receive systemic thrombolysis between two groups (all P<0.05). However, there was no difference in in-hospital mortality in APE between two groups (5.2% vs. 5.7%, P>0.05). On multivariate analysis, admission systolic blood pressure <90 mmHg, troponin Ⅰ>0.04 μg/L, moderate to severe pulmonary hypertension and pulmonary artery trunk and/or right and/or left main pulmonary artery embolism were significantly higher among those with syncope (all P<0.05). Syncope was an independent predictor of intermediate-high-risk and high risk APE ( P<0.05) after adjusting for age, sex, hemoptysis, admission heart rate >100 bpm, thrombus of lower extremity venous, lower extremity venous dilatation, the proportion of neutrophils and D-dimer. Conclusions More APE patients with syncope involved pulmonary artery trunk or right and/or left main pulmonary artery embolism, moderate to severe pulmonary hypertension, admission systolic blood pressure <90 mmHg and troponin Ⅰ>0.04 μg/L. Syncope might be related to intermediate-high-risk and high risk APE, but there is no significant association with high in-hospital mortality.