肺栓塞临床诊断与治疗

目的 :了解肺栓塞 (PE)的病因、症状、体征、诊断及治疗措施。方法 :回顾性分析 2 2例PE患者的年龄、性别、发病原因、临床表现及治疗方法等。结果 :2 2例中接受治疗 2 0例 (90 .9% ) ,其中 2例行导管介入碎栓及溶栓术 ,1例放置下腔静脉滤器 ,1例行肺动脉血栓切除术。治愈或改善 18例 (81.8% ) ,无效 2例 (9.1% ) ,2例未经治疗者死亡。结论 :PE主要由体循环静脉内血栓引起 ,源自下腔静脉系统最常见。PE常因症状无特异性 ,临床易出现误诊、误治。对易感患者应重视预防PE的发生 ,术后或因病卧床的患者早期活动、预防性抗凝治疗等均可有效地降低PE的发病率。对确诊者应立即给予抗凝、溶栓、肺动脉内膜剥脱术或肺动脉介入等相应的治疗。

Experience in clinical diagnosis and management o f pulmonary embolism

Objective:To report our experience in the diagnosis and therapy of pulmonary embolism (PE). Method:Retrospectively analyses the manifestations and management of 22 cases with PE in our hospital. Result:Twenty of all patients had been treated ( 90.9 %). Two of them received the thromboclastic and thrombolytic therapy with a percutaneous catheter technique. A vena cava filter was implanted in one patient, a pulmonary embolectomy was performed in other patient. 18 cases had recovered or improved ( 81.8 %) and 2 cases were unchanged ( 9.1 %). Two of 22 cases didn't receive any treatments and died ( 9.1 %).Conclusion: The thrombi of PE primarrily originate from systemic venous circulation, and most emboli arise from the vena cava. Because the symptoms of PE are unspecific, it may be difficult to make a clinical diagnosis and take an effective therapy. We should pay more attention to prevent PE, to advise the patients for early physical activity after operation or rest, to take prophylactic anticoagulation. Corresponding treatments must be performed as soon as a diagnosis of PE is established, which include anticoagulation, thrombolysis, pulmonary embolectomy and interventional therapy, et al.