关于30例肺栓塞患者的临床特征及诊治研究

Clinical Characteristics,Diagnosis and Treatment of 30 Patients with Pulmonary Embolism

目的:分析肺栓塞患者的临床特征及诊治效果。方法:选定本院收治的肺栓塞患者30例,研究时段从2014年1月至2018年3月,分析其临床特征、诊断、治疗方法。结果:6例单侧肢体肿胀、7例单侧肢体疼痛、12例晕厥、3例咯血、20发热、26例胸骨后疼痛、27例咳嗽、21例胸膜性胸痛、28例呼吸困难。22例口服新型抗凝药物或者华法林治疗。动脉血气分析:6例低氧血症,占20.00%;4例低碳酸血症,占13.33%。心肌钙蛋白检查:18例阳性,占60.00%;12例阴性,占40.00%。B型利钠肽检查:7例正常,占23.33%;23例增高,占76.67%。十二导联同步心电图:17例窦性心动过速,占56.67%;其中2例窦性心动过速异常,占11.76%;S13例,占17.65%,QⅢ5例,占29.41%,TⅢ4例,占23.53%。S1QⅢTⅢ3例,占17.65%。超声心动图:14例右室大,占46.67%。16例三尖瓣中重度返流,占53.33%。临床诊断:14例Wells评分在0~1分,占46.67%;16例Wells评分大于等于2分,占53.33%。15例Geneva评分在0~2分,占50.00%,15例Geneva评分大于等于3分,占50.00%。30例研究对象均以口服新型抗凝药物或者华法林治疗为主。26例好转、3例转院、1例死亡。结论:结合临床特征、实验室、影像学检查结果对肺栓塞患者病情做出最终诊断,采取针对性的治疗方法,可有效提高临床疗效。

Objective: To analyze the clinical features, diagnosis and treatment of patients with pulmonary embolism. Methods: Thirty patients with pulmonary embolism admitted to our hospital were selected. The clinical characteristics, diagnosis and treatment methods were analyzed from January 2014 to March 2018. Results: 6 cases of unilateral limb swelling, 7 cases of unilateral limb pain, 12 cases of syncope, 3 cases of hemoptysis, 20 fever, 26 cases of retrosternal pain, 27 cases of cough, 21 cases of pleural chest pain, 28 cases of dyspnea. 22 patients were treated with oral anticoagulant drugs or warfarin. Arterial blood gas analysis: 6 cases of hypoxemia, accounting for 20.00%;4 cases of hypocapnia, accounting for 13.33%. Cardiac troponin examination: 18 cases were positive, accounting for 60.00%;12 cases were negative, accounting for 40.00%. B-type natriuretic peptide examination: 7 cases were normal, accounting for 23.33%;23 cases were increased, accounting for 76.67%. 12-lead synchronous electrocardiogram: 17 cases of sinus tachycardia, accounting for 56.67%;2 cases of sinus tachycardia abnormalities, accounting for 11.76%;S13 cases, accounting for 17.65%, Q Ⅲ 5 cases, accounting for 29.41%, T Ⅲ 4 cases, Accounted for 23.53%. 3 cases of S 1 Q Ⅲ T Ⅲ, accounting for 17.65%. Echocardiography: 14 cases of right ventricle, accounting for 46.67%. 16 cases of severe tricuspid regurgitation, accounting for 53.33%. Clinical diagnosis: 14 cases of Wells scored at 0~1 points, accounting for 46.67%;16 cases of Wells score was greater than or equal to 2 points, accounting for 53.33%. 15 cases of Geneva scored 0~2 points, accounting for 50.00%, 15 cases of Geneva score was greater than or equal to 3 points, accounting for 50.00%. Thirty patients were treated with oral new anticoagulant drugs or warfarin. 26 cases were improved, 3 cases were transferred to hospital, and 1 case died. Conclusion: Combined with clinical features, laboratory and imaging findings, the final diagnosis of patients with pulmonary embolism can be made. The targeted treatment can effectively improve the clinical efficacy.