高原地区不同海拔高度急性肺栓塞临床特征分析

Clinical characteristics of acute pulmonary embolism at different altitudes in plateau areas

目的探讨高原地区不同海拔来源肺栓塞患者的临床特征.方法采用回顾性横断面研究分析西藏自治区人民医院2014年8月至2018年12月收治的106例肺栓塞患者,根据发病前长期居住地海拔高度分为3组:较低海拔组44例(2 700 m≤居住海拔≤3 700 m),其中男21例,女23例,年龄63(44~72)岁;中海拔高海拔组30例(3 700 m<居住海拔≤4 000 m),其中男15例,女15例,年龄62 (41~73)岁;高海拔组32例(4 000 m<居住海拔≤4 800 m),其中男10例,女22例,年龄61(41~72)岁.所有患者通过肺动脉造影或肺动脉CT血管造影检查确诊.分析各组患者的一般资料、辅助检查及危险分层.结果 3组患者比较,中海拔组胸痛发生率(21/30)高于较低海拔组(18/44),高海拔组呼吸困难发生率(30/32)高于中海拔组(20/30),高海拔组合并下肢骨折发生率(14/32)高于较低海拔组(7/44).高海拔组PaO2为52(44~64)mmHg(1 mmHg=0.133 kPa),低于较低海拔组[60(53~73) mmHg];高海拔组血红蛋白为(163±43)g/L,D-二聚体为5.6(3.7~12.6)mg/L,均高于较低海拔组[分别为(144±39)g/L和3.8(2.0~7.5)mg/L],组间差异有统计学意义(均P<0.05).3组患者危险分层均为中危或低危,3组间差异无统计学意义(P>0.05).低危患者中,高海拔组D-二聚体为5.8(4.2~14.8)mg/L,高于较低海拔组[3.6(2.3~5.8)mg/L,P<0.05].中危患者中,高海拔组PaO2为47(36~58)mmHg,低于较低海拔组[60(52~68)mmHg,P<0.05].结论高原地区不同海拔来源的肺栓塞患者的危险分层无差异,但长期居住在更高海拔地区的患者常伴有更显著的低氧血症以及血红蛋白和D-二聚体升高.

Objective To analyze the clinical characteristics of pulmonary embolism patients from different altitudes in plateau areas. Methods A retrospective cross-sectional study was used to analyze the patients with acute pulmonary embolism diagnosed definitely by pulmonary angiography or pulmonary artery CT angiography admitted to Tibet Autonomous Region People's Hospital from August 2014 to December 2018. The subjects were divided into 3 groups according to the altitude of long-term residence before onset, i.e. low-altitude group (group 1, 2 700 m ≤ altitude ≤3 700 m, n=44), mediualtitude group (group 2, 3 700 m<altitude ≤4 000 m, n=30) and high altitude group (group 3, 4 000 m<altitude≤4 800 m, n=32). The clinical data, auxiliary examination and risk stratification of pulmonary embolism patients at different altitudes were compared and analyzed. Results The incidence of chest pain, dyspnea and lower limb fracture in the three groups were statistically significant (P<0.05). The incidence of chest pain in group 2 (70%) was higher than that in group 1(40.9%), and dyspnea in group 3 (93.8%) was higher than that in group 2(66.7%), while lower limb fracture in group 3 (43.8%) was higher than that in group 1(15.9%). The differences in arterial oxygen partial pressure, hemoglobin and D-dimer among the three groups were statistically significant (P<0.05). The arterial oxygen partial pressure [52(43.5-63.5)mmHg] in group 3 was lower than that in group 1 [60 (53.25-73) mmHg]. The hemoglobin (163.1 ±43.3 g/L) and D-dimer [5.6 (3.7-12.6)mg/L] in group 3 were higher than those in group 1 [143.5 ±38.9 g/L and 3.8(2.0-7.5)mg/L respectively]. The risk stratification of the three groups of patients was moderate or low, and there was no statistical difference among the three groups. In patients with the same low-risk grade, the D-dimer in group 3 was higher than that in group 1 [5.8(4.2-14.8)mg / L and 3.6(2.3-5.8)mg / L respectively, P<0.05]. In patients with the same moderate risk level, the arterial oxygen partial pressure in group 3 was lower than that in group 1 [47.0(36.0-58.0)mmHg and 59.5(52.3-68.5)mmHg, respectively, P<0.05]. Conclusion There was no difference in the risk stratification of pulmonary embolism from different altitudes in plateau areas, but patients who lived at higher altitudes for a long time showed more significant hypoxemia and increased hemoglobin and D-dimer levels.