高危与非高危肺栓塞患者的临床特征及治疗、预后分析

Clinical Characteristics,Treatment and Prognosis of Patients with High-risk and None High-risk Pulmonary Embolism

背景高危肺栓塞(HR-PE)临床病死率较高,而了解该类患者的临床特征对提高临床诊断率具有重要意义。目的分析HR-PE与非HR-PE患者的临床特征及治疗、预后,以为临床诊疗提供参考。方法选取2017—2019年武汉亚洲心脏病医院收治的急性肺栓塞患者148例,血流动力学稳定者采用肺动脉计算机体层成像(CTPA)检查确诊,血流动力学不稳定、无法行CTPA检查者需由超声心动图联合D-二聚体水平诊断确诊。根据危险分层将所有患者分为高危组25例和非高危组123例。比较两组患者入院时临床症状及体征、CTPA检查结果、超声心动图及心电图检查结果、实验室检查指标、主要治疗方法及临床结局。结果高危组患者呼吸困难、晕厥发生率高于非高危组,收缩压、舒张压及指脉血氧饱和度(SpO2)低于非高危组,呼吸频率、心率快于非高危组(P<0.05)。高危组患者主肺动脉血栓发生率高于非高危组,肺动脉干血栓、肺动脉分支血栓发生率低于非高危组(P<0.05)。高危组患者右心房舒张末期内径、右心室舒张末期内径、肺动脉压大于非高危组,左心室射血分数低于非高危组(P<0.05)。高危组患者动脉血氧饱和度(SaO2)≤90%、N末端脑钠肽前体(NT-proBNP)>125 ng/L发生率及白细胞计数(WBC)、肌酐高于非高危组(P<0.05)。高危组患者溶栓治疗率、院内病死率高于非高危组(P<0.05)。结论HR-PE患者多伴有晕厥、低血压及低氧血症,存在右心功能障碍,易导致血栓形成,预后差,临床医生需根据患者临床症状、病史并结合CTPA、超声心动图、D-二聚体等检查早期识别HR-PE并及时给予再灌注治疗,以降低病死率。

Background High-risk pulmonary embolism(HR-PE)has a high clinical mortality rate,and understanding the clinical characteristics of these patients is of great significance to improve the clinical diagnosis rate.Objective To analyse the clinical characteristics,treatment and prognosis of patients with HR-PE and none HR-PE,in order to provide reference for clinical diagnosis and treatment.Methods From 2017 to 2019,a total of 148 patients with acute pulmonary embolism in Wuhan Asia Heart Hospital were selected,patients with stable hemodynamics were confirmed by CTPA examination,patients with unstable hemodynamics and unable to underwent CTPA should be diagnosed by echocardiography combined with D-dimer level diagnosis.All patients were divided into HR-PE group(n=25)and none HR-PE group(n=123)according to the risk stratification.Clinical symptoms and signs on admission,CTPA examination results,echocardiography results,electrocardiogram results,laboratory examination indexes,main treatment methods and clinical outcome were compared between the two groups.Results Incidence of dyspnea,faint in HR-PE group were higher than those in none HR-PE group,SBP,DBP and SpO2 in HR-PE group were lower than those in none HR-PE group,RR,HR in HR-PE group were faster than those in none HR-PE group(P<0.05).Incidence of thrombosis of main pulmonary artery in HR-PE group was higher than that in none HR-PE group,incidence of pulmonary arterial thrombosis and pulmonary artery branch thrombosis in HR-PE group were lower than those in none HR-PE group(P<0.05).Right atrium diastolic end of inner diameter,right ventricular diastolic end of inner diameter and pulmonary arterial pressure in HR-PE group were bigger than those in none HR-PE group,LVEF in HR-PE group was lower than that in none HR-PE group(P<0.05).Incidence of SaO2≤90%,NT-proBNP>125 ng/L and WBC,creatinine in HR-PE group were higher than those in none HR-PE group(P<0.05).Thrombolytic therapy rate,hospital mortality rate in HR-PE group were higher than those in none HR-PE group(P<0.05).Conclusion Patients with HR-PE are often accompanied by faint,hypopiesis and hyoxemia,with right heart dysfunction,which is easy to cause thrombosis and poor prognosis.Therefore,clinicians need to combine CTPA,echocardiogram and D-dimer level examination according to the patient's clinical symptoms and disease history to identify HR-PE early and give reperfusion therapy in time to reduce the mortality.