不同类型肺栓塞发病原因的临床分析

Causes of different types of pulmonary embolism

目的探讨不同类型肺栓塞发病原因的临床分析,为肺栓塞防治提供理论依据。方法收集2017年1月至2020年6月于空军军医大学第一附属医院的461例肺栓塞患者临床资料,分析不同类型肺栓塞的发病原因。结果461例肺栓塞患者中,71.6%静脉系统血栓导致;5.4%由心源性导致;21.0%不明原因导致;0.9%因咯血行介入栓塞手术导致;1.1%肺癌导致;49.7%大面积肺栓塞(MPE),4.4%中央型深静脉血栓形成(DVT)导致,28.4%混合型DVT导致,45.0%周围型DVT导致;50.3%非大面积肺栓塞(NMPE),2.2%中央型DVT导致,12.1%混合型DVT导致,44.4%周围型DVT导致。不同肺栓塞类型中孤立性小腿肌间静脉血栓发生情况比较,差异无统计学意义(P>0.05)。461例患者中,最终随访239例患者,平均随访时间(24.7±7.9)个月,痊愈88例,未痊愈151例。结论肺栓塞发病原因较多,下肢DVT是肺栓塞发病的主要原因,其中孤立性小腿肌间静脉血栓也不可忽视,针对不同发病原因给予早期治疗可较好预防肺栓塞发生。

Objective To investigate the causes of different types of pulmonary embolism,and to provide theoretical basis for prevention and treatment of pulmonary embolism.Method Clinical data of 461 patients with pulmonary embolism in the First Affiliated Hospital,Air Force Medical University from January 2017 to June 2020 were collected,and the causes of different types of pulmonary embolism were analyzed.Result In 461 cases of pulmonary embolism,71.6%were caused by venous thrombosis;5.4%were cardiogenic;21.0%were caused by unknown reasons;0.9%were caused by interventional intravascular embolization for hemoptysis;1%were caused by lung cancer;the incidence of massive pulmonary embolism(MPE)was 49.7%,central deep venous thrombosis(DVT)was 4.4%,mixed DVT was 28.4%,peripheral DVT was 45.0%;non massive pulmonary embolism(NMPE)accounted for 50.3%,central DVT accounted for 2.2%,mixed DVT accounted for 12.1%and peripheral DVT accounted for 44.4%.There was no significant difference in the incidence of isolated calf intermuscular venous thrombosis among different types of pulmonary embolism(P>0.05).239 patients were followed up with an average follow-up time of(24.7±7.9)months;88 cases were cured,151 cases were not cured.Conclusion There are many causes of pulmonary embolism.DVT of lower limbs is the main cause of pulmonary embolism,and isolated calf intramuscular venous thrombosis cannot be ignored.Early treatment for different causes can better prevent the pulmonary embolism.