36例致死性肺血栓栓塞临床病理分析

AN ANALYSIS OF THIRTY-SIX CASES OF FATAL PULMONARY THROMBOEMBOLISM CONFIRMED BY AUTOPSY

目的 进一步提高对致死性肺血栓栓塞症临床特点的认识。方法 回顾分析 1982年 11月～ 2 0 0 1年 2月经尸检证实的致死性肺血栓栓塞症 36例。结果 生前诊断仅 6例 ,合并有COPD、心血管疾病或恶性肿瘤的肺栓塞生前诊断率更低。有 4例患者无风险因素存在。临床多表现为呼吸困难突然发作或加重、晕厥、猝死 ,而胸痛及咯血少见 ,2 5 %的患者出现循环衰竭。对 4例采取了预防血栓栓塞的措施。结论 常见的与肺血栓栓塞相关的临床表现并不能作为致死性肺血栓栓塞的诊断依据 ,其原因主要是病人缺乏典型的症状及体征 ,并且存在交流困难(例如昏迷或麻醉 )。

Objective To determine the clinical characteristics of hospitalized patients who died of pulmonary thromboembolism (PTE) confirmed by autopsy. Methods The medical and autopsy records of 36 cases of autopsy proven fatal PTE in General Hospital of PLA from 1982 to 2001were reviewed. Cases of tumor embolism, fat embolism, and amniotic fluid embolism were excluded from the study. Results Six patients [16 7% (95% confidence interval, 6 4% to 32 8%)] were diagnosed as PTE prior to death. The diagnosis of PTE was significantly lower in patients with COPD or coronary artery disease. No risk factors were noted in only 4 patients (13 9%). Only a minority of patients had pleuritic pain or hemoptysis(8 3% and 11 1% respectively), while a significantly larger proportion of patients (25%, P <0 05) experienced circulatory collapse. Prophylactic measures against thromboembolism had been used in 4 patients. Conclusion Fatal PTE could not be diagnosed on the basis of its common clinical manifestations, because of lack of typical symptoms and signs. Furthermore, there was often lack of verbal exchange between the patient and physician, and sudden death of the patient and the pre existence of other illnesses added further the difficulty in correct diagnosis.