急性肺栓塞诊断治疗的临床分析及探讨

Clinical analysis on the diagnosis and treatment of acute pulmonary embolism

目的 探讨肺栓塞危险因素与发病的关系、急性肺栓塞的正确诊断程序及治疗措施。方法 对 1 990～ 2 0 0 1年确诊的 1 0 6例急性肺栓塞患者的易患因素、辅助检查、治疗方法及转归进行临床评估分析。结果 60～ 70岁肺栓塞患者所占的比例最高。 1 0 6例肺栓塞患者中 ,超声心动图呈典型改变者占 74.6 % ,血气分析示低氧血症者占 61 .9% ,D 二聚体 (D dimer) >50 0 μg/L占 84.1 % ,放射性肺核素扫描提示呈肺段分布的灌注缺损并与通气不匹配者占 87.5 %。螺旋CT及肺动脉造影诊断敏感性分别为 93 %及 1 0 0 %。接受溶栓治疗 2 2例 ,死亡 2例 ;未接受溶栓治疗 84例 ,死亡 1 4例。随访中复发 4例 ,国际标准化比率 (INR)均未达有效抗凝水平。结论 肺栓塞发病率与易患因素密切相关 ;对于血流动力学不稳定的急性肺栓塞 ,床旁无创检查可快速确立诊断并指导治疗 ;

Objective To investigate the relationship between the predisposing factors and onset of acute pulmonary embolism and to develop a simple and proper diagnostic strategy and clinical management for patients with pulmonary embolism.Methods The predisposing factors,clinical assessment,treatment and outcomes of 106 consecutive patients with established acute pulmonary embolism were analyzed retrospectively.Results The prevalence of pulmonary embolism was higher at the age of 60-70 years.In all 106 patients with pulmonary embolism,74.6% had typical findings on ultrasonic cardiogram,61.9% had hypoxemia,84.1% had D Dimer>500 μg/L,87.5% had at least one segmental perfusion defect and focally normal ventilation.The sensitivity of CT and pulmonary angiography were 93% and 100%,respectively.Twenty two patients received thrombolytic therapy,two of them died.The other 84 patients did not receive thrombolytic therapy,14 of them died.Four patients recurred during follow up period,the NIR value in these patients did not reach the effective anticogulant level. WT5'HZ]Conclusion Conclusion The incidence of pulmonary embolism is closely related to the associated factors.For patients with unstable hemodynamic status,bedside non invasive examination is a valuable tool to make a correct diagnosis immediately.Thrombolytic treatment can improve the survival rate of patients with acute pulmonary embolism.