影响急性肺栓塞预后的相关因素分析

目的:探讨影响急性肺栓塞预后的相关因素?方法:回顾性分析245例急性肺栓塞患者的资料并完成随访,将其分为急性期死亡组?后期死亡组及预后良好组,对各组患者的临床资料及死亡原因进行比较?结果:3组患者年龄?性别?吸烟史?合并高血压?糖尿病?冠心病?风心病?慢性肾病?结缔组织病?妊娠及脑血管病的比例无显著性差异?两死亡组合并恶性肿瘤?慢性心衰的比例较高,急性期死亡组合并感染性疾病的比例较高?后期死亡组合并慢性肺病的比例较高,预后良好组有发病前手术史的比例较高?恶性肿瘤进展是两组患者最主要的死因,后期死亡组还有相当比例的患者死于慢性血栓栓塞性肺动脉高压及消化道出血?结论:规范治疗后,部分血栓危险因素的存在可能并不会显著影响患者的预后,但合并恶性肿瘤?慢性肺部疾病?慢性心衰?严重感染性疾病则提示预后不良,以休克及简化肺栓塞严重指数评分为基础的危险分层是评估患者预后的有效方法,在长期随访中要关注慢性肺血栓栓塞性肺动脉高压的发生及消化道出血的预防?

Correlation analysis of acute pulmonary embolism prognosis

Objective:To investigate the factors influencing the prognosis of patients with acute pulmonary embolism. Methods:The data of 245 patients with acute pulmonary embolism were analyzed retrospectively and the follow-up-visits were completed. The patients were divided into three groups including the acute phase death group,the late death group and the good prognosis group. The clinical data and the reasons of death were compared. Results:There were no significant differences in age,sex,smoking history,hypertension,diabetes,coronary heart disease,rheumatic heart disease,chronic kidney disease,connective tissue disease,pregnancy and cerebrovascular disease in the 3 groups. However,the ratios of malignant tumor and chronic heart failure in the two death groups were significantly higher than that in the good prognosis group,and the ratio of infectious diseases in the acute phase death group was significantly higher than that in the other two groups. Besides,the ratio of chronic lung disease in the late death group was significantly higher than that in the other two groups,and the ratio of surgical history in the good prognosis group was significantly higher than that in the other two groups. The progress of malignant tumor was the main reason of death in all patients. Moreover,there was a considerable proportion of patients died of chronic thromboembolic pulmonary artery hypertension and gastrointestinal bleeding in the late death group. Conclusion:After standard treatment,some of the risky factors of thrombosis did not significantly affect the prognosis of patients. On the other hand,malignant tumors,chronic lung disease,chronic heart failure and serious infectious disease could indicate bad prognosis of acute pulmonary embolism. The risk-stratification based on shock and simplified pulmonary embolism severity index score is an effective method to evaluate the prognosis of patients. We could focus on the occurrence of chronic thromboembolic pulmonary arterial hypertension and digestive tract hemorrhage in the long term follow-up-visits.