50例肺癌合并肺栓塞的临床诊治分析

目的探讨肺癌合并肺栓塞患者的临床特点与治疗方法,为诊治该病提供参考。方法采取回顾性的方法对本院2010-01/2014-12间的50例肺癌合并肺栓塞的临床资料进行分析,包括一般资料和实验室检查以及临床治疗方法。结果 50例患者表现为呼吸困难、咳嗽与咳痰、胸痛、晕厥和咳血特征,比例分别为64.0%、16.0%、12.0%、4.0%、4.0%;肺癌合并肺栓塞并发高血压、深静脉血栓、慢性阻塞性肺疾病(简称慢阻肺)和冠心病以及糖尿病与心房纤颤等,比例40.0%、24.0%、18.0%、10.0%、4.0%、4.0%;血液学检查表现为D-二聚体升高、乳酸脱氢酶升高、癌胚抗原升高、细胞角蛋白19升高、碱性磷酸酶升高、鳞癌相关抗原升高和Pa O280 mm Hg以及Pa CO235.0 mm Hg等。50例中4例尿激酶溶栓治疗后给予抗凝治疗,剩余46例患者皮下注射5000 U低分子肝素,每12 h一次,连续治疗7天,治疗第三天口服华法林抗凝治疗。抗凝治疗之后继续抗肿瘤治疗,化疗治疗38例,靶向治疗12例。结论肺癌合并肺栓塞在临床中表现多样性,多数患者为腺癌,且处于中晚期,同时,D-二聚体、乳酸脱氢酶的升高。低分子肝素钙抗凝治疗对该病的治疗具有较好的效果,能提高整体效果。

Clinical diagnosis and treatment of 50 lung cancer patients complicated with pulmonary embolism

Objective To investigate the clinical features and treatment methods of pulmonary embolism in patients with lung cancer, in order to provide a reference for future diagnosis and treatment of the disease. Methods The clinical data of 50 lung cancer patients complicated with pulmonary embolism from Jan, 2010 to Dec, 2014 were retrospectively analyzed, including general information and laboratory tests and clinical treatment. Results 50 cases of patients presented with dyspnea, cough and sputum production, chest pain, fainting and coughing up (64. 0%, 16. 0%, 12. 0%, 4. 0%, and 4. 0%). There were 40% cases with lung cancer, 24% with pulmonary embolism complicated with hypertension, 18% with deep vein thrombosis, 10% with chronic obstructive pulmonary disease ( COPD) , 4% with coronary heart disease and diabetes, and 4% with atrial fibrillation. Blood tests showed the levels of D-dimer, lactate dehydrogenase increased, carcinoembryonic antigen, cytokeratin 19, elevated alkaline phosphatase and SCC antigen increased, the level of PO2 was less than 80 mmHg and the level of PCO2 was less than 35. 0 mmHg. 4 cases after urokinase thrombolysis were given anti-coagulation therapy, and the remaining 46 patients were given 5000 U subcutaneous low molecular weight heparin, every 12 hours for 7 days. On the third day, they were given oral warfarin therapy. After anti-coagulant therapy, they received anti-cancer therapy, including chemo-therapy for 38 cases and targeted therapy for 12 cases. Conclusion The clinical manifestations of lung cancer pa-tients complicated with pulmonary embolism are diversity, and the majority of patients show adenocarcinoma, at mid-dle and advanced stage. At the same time, those patients often show the high level of D-dimer and lactic dehydrogen-ase. Low molecular weight heparin anti-coagulant therapy has better curative effect and can improve the overall effect in the treatment of lung cancer patients complicated with pulmonary embolism.