142例肺栓塞的临床特点及危险因素分析

Clinical features and risk factors of pulmonary embolism

目的分析不同严重程度肺栓塞的临床特点及危险因素,合理评估患者病情,为临床早期干预提供参考。方法收集近5年于西南医科大学附属医院诊治142例肺栓塞的临床资料,参照中华医学会呼吸病学指南将其分为低危组和中高危组,低危组72例,中高危组70例。回顾性分析其一般情况、既往史、临床表现、相关检查、治疗与转归等,比较两组有无统计学差异,并采用单因素Logistic回归分析发生不同严重程度肺栓塞的危险因素。结果肺栓塞的基础病因主要为下肢骨折、下肢静脉曲张、肿瘤、手术治疗后、心脏瓣膜病、肾病综合征、抗磷脂抗体综合征等;两组临床症状咳嗽咳痰、心悸、呼吸困难、咯血、胸痛、下肢肿痛无统计学差异(P=0. 483、0. 791、0. 741、0. 322、0. 542、0513),晕厥存在统计学差异(P=0. 031)); D-2聚体、FDP、BNP差异具有统计学意义(P=0. 036、0. 018、0. 024); 85例合并下肢静脉血栓,共39例行下腔静脉滤器植入术,8例行肺动脉造影+置管溶栓术;单因素Logistic回归分析显示年龄≥75岁、合并冠心病、D-2聚体≥7. 3ug/m L、氧分压<60mmHg(P=0. 024、0. 038、0. 001、0. 009)是发生中高危肺栓塞的独立危险因素。结论肺栓塞基础病因复杂,临床表现无特异性,临床需结合年龄、冠心病、D-2聚体、血气等及时评估病情,早期干预。

Objective To analyze the clinical features and risk factors of pulmonary embolism with different severity,and to evaluate the condition of patients reasonably,so as to provide reference for early clinical intervention.Methods The clinical data of 142 cases of pulmonary embolism diagnosed and treated in the Affiliated Hospital of Southwestern Medical University in the past 5 years were collected,which were divided into the low-risk group and the high-risk group according to the Chinese Medical Association's respiratory guidelines,included 72 cases in the low-risk group and 70 cases in the high-risk group.Their general conditions,past history,clinical manifestations,examinations,treatment and prognosis were analyzed retrospectively and difference was compared statistically.Meanwhile,univariate logistic regression analysis was used to analyze risk factors for pulmonary embolism.Results The causes of pulmonary embolism mainly concluded fractures of lower limb,varicose veins of the lower extremities,tumors,surgery,valvular heart disease,nephrotic syndrome,and antiphospholipid antibody syndrome.There were no statistical difference in cough,heart palpitation,dyspnea,hemoptysis,chest pain,lower extremity swelling and pain(P=0.483,0.791,0.741,0.322,0.542,and 0513),but there was statistical difference in syncope(P=0.031).There were statistical differences in D-dimer,FDP,and BNP(P=0.036,0.018,0.024).85 cases had venous thrombosis in the lower extremity.A total of 39 patients underwent inferior venacava filter implantation,and 8 patients underwent pulmonary angiography and catheter thrombolysis.Univariate logistic regression analysis revealed that age≥75 years,with coronary heart disease,D-dimer≥7.3ug/mL,oxygen pressure<60 mmHg(P=0.024,0.038,0.001,0.009)were independent risk factors for the occurrence of high-risk pulmonary embolism.Conclusion The causes of pulmonary embolism are complicated and its clinical manifestations are non-specific,which is necessary to assess the condition of the disease in combination with age,coronary heart disease,D-dimer,and blood gas timely.