摘要
目的探讨急性肺血栓栓塞症(PTE)的临床特点。方法收集经CT肺动脉造影(CTPA)确诊的185例PTE患者的临床资料,总结其发生PTE的危险因素,临床表现、辅助检查及治疗、预后。同时,按年龄将患者分为两组,高龄组(年龄>40岁)139例和非高龄组(年龄≤40岁)46例,比较两组患者的临床特征。结果本组急性PTE患者的危险因素主要分布为年龄(>40岁,75.1%),其次为下肢静脉血栓形成(DVT,45.9%)和急性感染性疾病(33.0%)。PTE最常见的症状是呼吸困难(68.1%),最常见的体征为呼吸频率加快(35.1%),动脉血气分析主要表现为低氧血症合并低碳酸血症(36.6%)及低氧血症(33.8%),血浆D-二聚体>500μg/L者占70.9%,胸部X线片主要表现为片状浸润影(49.6%),心电图主要表现为窦性心动过速(21.1%),心脏彩色多普勒超声检查主要表现为肺动脉高压(46.8%)。单纯抗凝治疗135例,溶栓治疗35例,放置下腔静脉滤器植入术5例,肺动脉取栓术1例,放弃治疗出院9例。经治疗的176例患者中,病情好转164例(88.7%),恶化6例(3.2%),死亡6例(3.2%)。高龄组患者的高血压病、糖尿病的发病率明显高于非高龄组,非高龄组肾病综合征的发病率明显高于高龄组,P均<0.01;高龄组咯血的发生率明显低于非高龄组,无明显体征者也高于非高龄组,P均<0.05。结论急性PTE患者主要临床特征为呼吸困难、低氧血症、高水平D-二聚体、胸部片状影、肺动脉高压,经治疗后多数患者好转,高龄、下肢静脉血栓形成的患者如出现呼吸困难要警惕PTE的可能,急性感染性疾病是引起急性PTE的高危因素之一。不同年龄患者临床表现可有不同。
Objective To explore the clinical characteristics of pulmonary thromboembolism（PTE）.Method The clinical data of 1 85 PTE patients diagnosed by CT pulmonary angiography were collected,and their clinical characteristics,diagnosis and treatment were analyzed. Meanwhile,the patients were divided into two groups according to age,the older group （age ＆gt;40 years,n=1 39 ）and non-elderly group （age ≤ 40 years,n=46）,and their clinical characteristics were compared. Result The most common risk factors were age （＆gt;40 years old,75.1%） and deep vein thromboembolism （45.9%） and acute infectious diseases （33.0%）. Dyspnea was the main symptom in patients with PTE （68.1%）,otherwise shortness of breath was the main sign in patients with PTE （35.1%）. The arterial blood gas mostly showed hypocapnia and hypoxemia （36.6%）,hypoxemia （33.8%）. Patients whose D-dimer was more than 500 μg/L accounted for 70.9%.The main sign of chest X-ray was infiltration （49.6%）. Sinus tachycardia （21.1%）was the most common abnormality in electrocardiogram. The main sign of echocardiography was Pulmonary hypertension （46.8%）.1 35 cases received anticoagulation,35 cases received thrombolytic therapy,5 cases received implanting inferior vena cave filter tube therapy,one case received pulmonary embolectomy and 9 cases refused treatment. 1 64 ca-ses （88.7%）got improved,6 cases （3.2%）got progress and 6 cases （3.2%）died after treatment. The in-cidence of hypertension and diabetes in elderly group was significantly higher than those in non-elderly group.Meanwhile,the incidence of nephritic syndrome in non-elderly group was significantly higher than that in elder-ly group,P〈0.01. Percentage of hemoptysis in the elderly group was significantly lower than that in non-eld-erly group,and percentage of patients without obvious signs were also higher than that in non-elderly group,P〈0.05. Conclusion The main clinical characteristics of acute PTE patients were dyspnea,hypoxemia,high D-Dimer an
出处
《新医学》
2014年第1期25-29,共5页
Journal of New Medicine
关键词
肺血栓栓塞症
诊断
治疗
预后
Pulmonary thromboembolism
Diagnosis
Treatment
Prognosis
