年龄调整后D-二聚体阴性肺栓塞患者的特征分析

Clinical features of patients with age-adjusted D-dimer negative pulmonary embolism

目的回顾性分析经年龄调整后D-二聚体阴性肺栓塞患者的临床特征,探讨减少漏诊、误诊方法。方法随机抽取2017年5月至2019年5月就诊于新疆自治区人民医院完善CTPA检查并年龄调整后D-二聚体阴性的患者20例。回顾性分析患者临床指标,进行临床可能性评分、危险分层,讨论年龄调整后D-二聚体阴性患者临床特征。结果 800例患者中确诊肺栓塞的患者198例,其中经年龄调整D-二聚体阴性患者占确诊病人10.1%,占疑似病人2.5%,为20例,。分析年龄调整D-二聚体阴性患者特征,临床症状最多见的为气短12例(占60%),胸闷10例(占50%),胸痛7例(占35%);出现低氧血症(PO2<80mmHg)的15例(占75%)。修订版Geneva评分较简化的Wells评分标准预测价值更好。进行肺栓塞危险分层:中危以上15例(占75%),s PESI指数中危以上9例(占45%),预后死亡4例(占20%),复发1例(占5%)。结论在临床上肺栓塞的症状不典型,而年龄调整后的D-二聚体阴性的肺栓塞患者更容易出现误诊与漏诊,但此类患者如不能及时诊断,影响预后。临床医师需要提高对D-二聚体阴性肺栓塞患者的认知,尤其当患者出现低氧血症、病程较长的情况下需要结合临床可能性评估帮助识别。

Objective To retrospectively analyze the clinical characteristics of patients with age-adjusted D-dimer negative pulmonary embolism, and to explore some ways to reduce missed diagnosis and misdiagnosis. Methods Twenty patients who had been diagnosed with age-adjusted D-dimer negative pulmonary embolism through complete CTPA test in People’s hospital of Xinjiang autonomous region from May 2017 to May 2019 were randomly selected. The clinical indicators of the patients were retrospectively analyzed, the clinical possibility and risk stratification were conducted, and the clinical characteristics of patients with D-dimer negative after age adjustment were discussed. Results Among 800 patients, 198 cases were diagnosed with pulmonary embolism, of which 20 cases were age-adjusted D-dimer negative, accounting for 10.1% among the confirmed patients and 2.5% among the suspected patients.The characteristics of age-adjusted D-dimer negative patients were analyzed, and the most common clinical symptom was shortness of breath in 12 cases(accounting for 60%), chest tightness in 10 cases(accounting for 50%)and chest pain in 7 cases(accounting for35%). Hypoxemia(PO2< 80 mm Hg)occurred in 15 patients(accounting for 75%). The revised Geneva score is a better predictor than the simplified Wells score. Risk stratification of pulmonary embolism was performed and 15 patients had medium risk(accounting for75%), 9 patients were in medium risk according to s PESI index, accounting for 45%. 4 patients were dead(20%), and 1 patients had recurrence(5%). Conclusion The clinical symptoms of pulmonary embolism are not typical, and patients with age-adjusted D-dimer negative pulmonary embolism are more likely to have misdiagnosis and missed diagnosis. But the failure of timely diagnosis in such patients will affect the prognosis. Clinicians need to improve the cognition of patients with D-dimer negative pulmonary embolism, and diagnose the disease combined with clinical possibility assessment especially when patients get hypoxemia with a long course of disease.