50例高海拔地区急性肺栓塞患者的临床特征分析

Clinical characteristics of 50 cases of acute pulmonary embolism at high altitude

目的探讨50例高海拔地区急性肺栓塞患者的临床特点。方法收集2017年1月至2022年10月于青海省心脑血管病专科医院就诊的50例急性肺栓塞患者的临床资料,按照危险分层的不同将其分为低危-中低危组(n=27)与中高危-高危组(n=23),两组患者均皮下注射低分子量肝素,中高危-高危组患者静脉滴注重组组织型纤溶酶原激活剂。收集所有患者的临床资料、实验室检测结果、影像学检查结果,分析高海拔地区患者发生肺栓塞的危险因素、临床表现、治疗情况及住院结局情况。结果50例高海拔地区患者发生肺栓塞的危险因素以获得性危险因素为主,主要临床表现包括呼吸困难23例、胸痛19例、咳嗽11例、咯血6例、晕厥3例、无症状7例。心电图检查示窦性心动过速37例、S_(I)Q_(Ⅲ)T_(Ⅲ)5例、右束支传导阻滞6例、新发心房颤动3例。心脏超声检查示肺动脉高压25例、右心室扩大12例。中高危-高危组患者年龄、D-二聚体水平及心动过速、肺动脉高压、呼吸困难、胸痛的比例均高于低危-中低危组患者,差异均有统计学意义(P﹤0.05)。所有患者均接受低分子量肝素抗凝治疗,22例患者接受了重组组织型纤溶酶原激活剂溶栓治疗,最终成功溶栓19例,未发生死亡患者。结论50例肺栓塞患者临床表现以呼吸困难、胸痛、咳嗽较为常见,临床表现不典型患者比例较高,高危比例较低,发生肺栓塞的危险因素仍以获得性因素为主,抗凝治疗及溶栓治疗效果均较好。

Objective To explore the clinical characteristics of 50 patients with acute pulmonary embolism at high altitude.Method Clinical data of 50 patients with acute pulmonary embolism treated in the Qinghai Cardio Cerebrovascular Hospital from January 2017 to October 2022 were collected.According to the risks,all patients were divided into low-medium risk group(n=27)and medium-high risk group(n=23).Patients in both groups were given subcutaneous injection of low molecular weight heparin,while patients in medium-high risk group were given additional intravenous infusion of recombinant tissue plasminogen activator.The clinical data,laboratory test results and imaging results of all patients were collected,the risk factors,clinical manifestations,treatment and hospitalization outcomes of patients with pulmonary embolism at high altitude were analyzed.Result The main risk factors of 50 patients with pulmonary embolism were acquired risk factors.The main clinical manifestations included dyspnea in 23 cases,chest pain in 19 cases,cough in 11 cases,hemoptysis in 6 cases,syncope in 3 cases,and asymptomatic in 7 cases.ECG showed sinus tachycardia in 37 cases,S_(I)Q_(Ⅲ)T_(Ⅲ) in 5 cases,right bundle branch block in 6 cases,and new atrial fibrillation in 3 cases.Cardiac ultrasound showed pulmonary hypertension in 21 cases and right ventricular enlargement in 12 cases.Age,D-dimer level,proportion of patients with tachycardia,pulmonary hypertension,and dyspnea and chest pain in medium-high risk group were higher than those in low-medium risk group,the differences were statistically significant(P<0.05).All patients received anticoagulant therapy with low molecular weight heparin,22 patients received thrombolytic therapy with recombinant tissue plasminogen activator,19 patients finally successfully thrombolized without death case.Conclusion In this study,the clinical manifestations of 50 patients with pulmonary embolism are mainly dyspnea,chest pain and cough,with a high proportion of patients with atypical clinical manifestations and a low proportion of high-risk patients.The risk factors for pulmonary embolism are still mainly acquired factors,and the effects of anticoagulation and thrombolytic therapy are good.