急性肺动脉血栓栓塞症122例临床分析

目的分析急性肺动脉血栓栓塞症(PTE)的临床特征以及溶栓、抗凝治疗的疗效,以期降低其漏诊率和误诊率,提高存活率。方法回顾性分析2002年1月至2006年12月沈阳军区总医院呼吸内科住院的122例急性PTE患者的危险因素、临床表现、辅助检查及治疗方案等临床资料。结果急性PTE的危险因素有高龄、高血压等心脏基础疾病以及近期手术、糖尿病、骨折、长期卧床等。临床症状以呼吸困难最为常见,出现"三联征"症状(呼吸困难、胸痛、咯血)的为数极少。D-二聚体对急性PTE具有高度敏感性,结合心脏超声、CT肺动脉造影(CTPA)、肺通气/灌注扫描等检查结果可明确诊断。积极予以溶栓、抗凝治疗可降低病死率。结论急性PTE临床症状多种多样,临床医生应高度警惕。D-二聚体可作为急性PTE筛选检查。确诊后进行规范化治疗可显著改善预后。

Clinical analysis of 122 cases of acute pulmonary thromboembolism

Objective To discuss clinical characteriistics of APE and therapeutic effect of thrombolysis or anticoagulation so as to reduce false or misdiagnosis rate and improve survival rate.Methods The clinical data of 122 inpatients with APE were reviewed.Results The most common risk factors were deep venous thrombosis,age over 60 years old,cardiac disease,surgical operation,diabetes,fracture,long-term immobilization,etc.The most frequent symptom was dyspnea.D-dimmer measure had high sensitivity.By means of color Doppler echocardiography,spiral computed tomography,pulmonary ventilation/perfusion scanning,the cases were finally diagnosed.Positive treatment of thrombolysis and anticoagulation could reduce mortality.Conclusion As clinical manifestations of APE are non-specific,clinician should be alert.D-dimmer measue could be screening.The standardized treatment can improve prognosis significantly.