肺栓塞合并下肢深静脉血栓患者的临床特征分析

The analysis of clinical characteristics of the pulmonary embolism complicated with deep vein thrombosis

目的:回顾性分析肺栓塞合并下肢深静脉血栓(DVT)患者的临床特征。方法:纳入2016年1月-2021年6月期间首次院内诊断的肺栓塞患者,根据有无DVT,分为肺栓塞合并DVT组和肺栓塞无DVT组,收集患者的资料信息,总结分析肺栓塞合并DVT的临床特征。结果:341例肺栓塞患者中有46例未完善下肢静脉彩超,剔除后最终纳入295例患者,其中肺栓塞合并DVT组有165例,肺栓塞无DVT组有130例。肺栓塞合并DVT患者的下肢疼痛发生率、D-二聚体水平、纤维蛋白降解产物(FDP)、肿瘤比例和双侧肺动脉栓塞比例均高于肺栓塞无DVT患者,均差异有统计学意义(P<0.05);在胸痛发生率、下肢水肿发生率和单侧叶段及以下的分支栓塞比例方面,肺栓塞合并DVT组均低于肺栓塞无DVT患者,均差异有统计学意义(P<0.05)。2组在手术、慢性心肺疾病、其他内科病、肺动脉干栓塞比例、单侧肺动脉栓塞比例、双侧叶段及以下的分支栓塞比例及高危、中高危、中低危、低危比例方面比较均差异无统计学意义(P>0.05)。结论:与肺栓塞无DVT患者比较,肺栓塞合并DVT患者的特征性症状是下肢疼痛,胸痛和下肢水肿不多见,血D-二聚体和FDP水平更高,血栓负荷大,合并肿瘤更多见,且双侧肺动脉栓塞的比例更高,临床应关注危险分层,重视DVT的筛查,加强随访。

Objective:To retrospectively analyze the clinical characteristics of patients with pulmonary embolism complicated with deep vein thrombosis(DVT).Methods:In the medical record system,pulmonary embolism diagnosed for the first time were collected from January 2016 to June 2021.According to the result of lower limb venous ultrasonography,they were divided into pulmonary embolism with DVT group and pulmonary embolism without DVT group.We collected the clinical information of cases to summary the clinical characteristics.Results:Among the 341 patients with pulmonary embolism,46 patients without lower extremity venous ultrasonography were eliminated.Two hundred and ninety-five patients,including 165 patients in the pulmonary embolism combined with DVT group and 130 in the pulmonary embolism without DVT group,were finally included.The incidence of lower extremity pain,D-Dimer level,FDP level,the proportion of tumor and bilateral pulmonary embolism in patients with pulmonary embolism combined with DVT were higher than those in patients with pulmonary embolism without DVT.The incidence of chest pain,the incidence of lower extremity edema and the proportion of branch embolism of unilateral lobe segment and below in patients with pulmonary embolism combined with DVT were lower than those in patients with pulmonary embolism without DVT.The differences were statistically significant(P<0.05).The differences between the two groups in the aspects of surgery,chronic cardiopulmonary disease,other medical diseases,pulmonary artery embolism ratio,unilateral pulmonary embolism ratio,bilateral lobe segment and below branch embolism ratio,high-risk ratio,medium-high-risk ratio,medium-low-risk ratio and low-risk ratio were not statistically significant(P>0.05).Conclusion:Compared with patients with pulmonary embolism without DVT,the characteristic symptom of patients with pulmonary embolism combined with DVT was lower extremity pain,while the chest pain and lower extremity edema were rare.They had a higher blood D-dimer level and FDP level with heavy thrombus burden,more tumors and higher ratio of bilateral pulmonary embolism.The medical should pay attention to risk stratification,the screening of DVT and strengthen follow-up for patients diagnosed with pulmonary embolism.