伴有晕厥症状的急性肺血栓栓塞症患者的临床特点分析

目的 回顾性分析25例伴有晕厥症状的急性肺血栓栓塞症(PTE)患者的临床特点及住院转归情况.方法 2011年1月至2015年12月期间北京医院确诊的289例PTE患者,按照是否伴有晕厥症状分为晕厥组和无晕厥组,记录两组患者年龄、性别、危险因素、临床症状、实验室检查、影像学特征、危险度分级、治疗情况和住院转归情况.结果 晕厥组25例,占所有PTE患者的8.7%,其中,男14例,女11例,平均(62.0±14.0)岁.晕厥组和无晕厥组在年龄、性别、基础疾病及危险因素等方面差异无统计学意义;晕厥组中心悸和发绀发生率高于无晕厥组(分别是36.0% vs 13.3%和24.0% vs 9.5%,P=0.002、0.030);心电图检查中,SⅠQⅢTⅢ表现的比例较无晕厥组差异有统计学意义(16.6% vs 2.9%,P=0.001);超声心动图检查中,右心室前后径/左心室前后径>0.6的比例较无晕厥组差异有统计学意义(50.0% vs 27.3%,P=0.034);晕厥组主肺动脉及肺动脉干受累的比例高于无晕厥组,两组差异有统计学意义(55.0% vs 29.8%,X2=5.34,P=0.021);晕厥组高、中危患者的比例要显著高于无晕厥组(76.0% vs 32.6%,X2=18.60,P<0.001).两组的全因死亡率差异无统计学意义(12.0% vs 9.8%,X2=0.12,P=0.730),但晕厥组死于PTE的比例较无晕厥组高(12.0% vs 2.6%,X2=5.87,P=0.015).结论 伴有晕厥症状的PTE患者常累及主肺动脉和肺动脉干,伴有右心功能不全,疾病危险程度更为严重,可能是疾病预后不佳的标志.

Clinical features and outcomes of acute pulmonary thromboembolism patients with syncope

Objective To identify the clinical picture and outcomes of acute pulmonary thromboembolism (PTE) patients with syncope.Methods From January 2011 to December 2015,289 consecutive patients with confirmed acute symptomatic PTE in Beijing hospital were divided in with and without syncope groups.The clinical factors including age,gender,predisposing factors,symptoms,labs,imagings,classification of PTE,therapeutic regimen and outcomes were recorded.Results From 289 patients,25 (8.7%) had syncope which included 14 men and 11 women (median age:62.0±14.0 year).There were no significant difference about age,gender,predisposing factors and comorbiditys between two groups.Compared to patients without syncope,those with syncope had a higher frequency of palpitation (36.0% vs 13.3%,P=0.002),cyanosis (24.0% vs 9.5%,P=0.03).SⅠQⅢTⅢ in ECG (16.6% vs 2.9%,P=0.001).RV/LV anteroposterior diameter ratio increase in echocardiographic findings were more common in syncope group(50.0% vs 27.3%,P=0.034).More patients with syncope involved lobe or main pulmonary artery (55.0% vs 29.8%,X2=5.34,P=0.021).There were more high and intermediate risk stratification patients in syncope group (76.0% vs 32.6%,X2=18.60,P<0.001).All-cause mortality in hospital showed no significant difference between two groups (12.0% vs 9.8%,X2=0.117,P=0.730),but more patients were dead of PTE in syncope group (12.0% vs 2.6%,X2=5.87,P=0.015).Conclusions More PTE patients with syncope involved lobe or main pulmonary artery and suffered right ventricle disfunction.The risk stratification was more severe.PTE with syncope might be a sign of deterioration.