70岁以上老年人肺血栓栓塞的临床特点分析

Clinical characters of pulmonary thromb-embolism in ≥70 elderly patients

目的 作者单位 :10 0 73 0卫生部北京医院急诊科 (齐海梅 ) ,呼吸科(刘兵 ) ,心脏科 (艾虎 )探讨 70岁以上老年人肺血栓栓塞 (简称肺栓塞 )的临床特点及溶栓、抗凝治疗的疗效。 方法 回顾性分析了 5 8例 70岁以上老年肺血栓栓塞患者的临床表现、诊断方法及溶栓、抗凝治疗的疗效。 结果 本组老年人因下肢深静脉血栓 (DVT)形成致肺栓塞者 4 3例占 ( 74 1% ) ;因制动或长期卧床致肺栓塞 2 8例占 ( 4 8 2 % )。以原因不明、程度不等的呼吸困难伴突发、持续性低氧血症为主要临床特征。螺旋CT肺动脉造影 (CTPA)和肺通气 /灌注扫描 (V/Q)检出阳性率分别为 95 7% ( 4 5 / 4 7)和 6 2 5 %( 2 0 / 32 ) ;误诊率为 4 6 5 % ;溶栓 +抗凝、抗凝、抗血小板凝聚治疗有效率分别为 91 3% ( 2 1/ 2 3)、75 8% ( 2 2 / 2 9)和 0 ( 0 / 6 ) ;治愈率分别为 4 7 8% ( 11/ 2 3)、17 2 % ( 5 / 2 9)和 0 ( 0 / 6 )。 结论 70岁以上老年人肺栓塞最常见危险因素为下肢深静脉血栓形成 ,其次为长时间的制动或卧床 ;临床表现复杂多样、不典型 ;CTPA对老年人肺栓塞诊断更具有可靠性和准确性 ;溶栓和抗凝治疗安全、有效 ,抗血小板凝聚治疗无效果 。

Objective To explore the clinical characteristics and effects of thrombolytic and anti coagulation treatment in over 70 year old patients with pulmonary thromb embolism(PTE). Methods The clinical findings, diagnostic techniques, effects of thrombolytic therapy and anti coagulation in 58 over 70 year old patients with PTE were analyzed retrospectively. Results Deep venous thrombosis (DVT) in lower limbs (74 1%) was the most common thrombolism prone factors in our study. Limitation of movement and long term stay in bed due to a variety of causes were in the next place. The clinical findings were atypical, associated with a false diagnostic ratio of 46 5% in elderly patients with PTE. Undefined causal and different degree of dyspnea along with sudden and persistent hypoxemia were the main characteristics. Spiral CT and radioactive nuclear ventilation perfusion scan were important methods for diagnosis of PTE with positive finding of 95 7% and 62 5%, respectively. The effective and cure rate of thrombolytic therapy combined with anti coagulation, anti coagulation and anti platelet therapy was 91 3%, 75 8%, 0 and 47 8%, 17 2%, 0, respectively. Conclusions The most common risk factors of PTE in the elderly was DVT and the long term stay in bed or stay without active moving. The clinical symptoms were not only atypical but also variable. Thrombolytic with anti coagulation therapy is safe and effective, but anti platelet coagulation alone is not benefit.