急性肺栓塞急诊及时诊断和治疗对患者疗效及预后的影响

目的:探讨急诊及时诊断和治疗对急性肺栓塞(APE)的疗效及随后1年的预后影响。方法:回顾性分析2007年5月～2011年6月我院收治的APE患者86例,按确诊时间是否超过2周,分为及时诊断和治疗组(观察组,47例)和未及时诊断和治疗组(对照组,39例),观察其疗效及随访1年的预后情况。结果:观察组2周内确诊后予溶栓联合抗凝治疗,对照组未在2周内确诊,予对症治疗,两组患者经不同方法治疗后呼吸频率、心率、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)和动脉血-肺泡气氧分压差(PA-aO2)均明显改善(P<0.05);观察组的动脉血氧分压(PaO2)治疗后较对照组有明显改善(P<0.05);观察组总有效率为93.7%(43/47),明显高于对照组(P<0.05);随访1年两组主要终点事件发生率无明显差异(P>0.05)。结论:急性肺栓塞在2周内确诊并联合应用溶栓和抗凝治疗,有利于提高疗效、减少死亡率,但不能改善1年后的无事件生存率。

Early diagnosis and treatment for acute pulmonary embolism

Objective: To explore the influence of early diagnosis and treatment for acute pulmonary embolism(APE) on patlents’ prognosis after 1 year.Methods: Clinical data of 86 patients diagnosed as APE from May 2007 to June 2011 were retrospective analyzed.According to diagnostic time,all cases were divided into observation group with timely diagnosis and treatment(47 cases) and control group without timely diagnosis and treatment group(39 cases).The curative effect and prognosis after 1-year follow-up were observed and compared.Results: Patients in observation group were diagnosed as APE in 2 weeks and were given thrombolysis combined with anticoagulant therapy,while patients in control group had no confirmed result in 2 weeks and had symptomatic treatment.After treatment,heart rate,respiration rate,blood oxygen partial pressure(PaO2),carbon dioxide points(PaCO2) and blood pressure-alveolar gas oxygen partial pressure(PA-a02) were significantly improved in both groups(P<0.05);PaO2 of observation group was better than that of control group(P<0.05);the total effective rate of the observation group was 93.7%(43/47),significantly higher than those in the control group(P<0.05);1-year follow-up showed that there was no significant difference in incidence of primary end-point event in two groups(P>0.05).Conclusions: Diagnosis in 2 weeks and combined treatment of thrombolysis and anticoagulation can improve the curative effect and reduce mortality,but it has little effect on event-free survival rate after one year.