30例肺血栓栓塞症的临床特征分析

目的:总结肺血栓栓塞症病例的特征.方法:回顾分析30例肺血栓栓塞症病例的科室分布、临床表现及治疗转归.结果:肺栓塞病例分布于9个科室,外科系占36.7%,内科系占63.3%;56.7%的肺栓塞患者有下肢深静脉血栓,其它常见原因有手术、外伤、骨折;多数肺栓塞病例缺乏特异性症状和体征,仅13.3%有呼吸困难、胸痛、咯血典型三联征;13.3%心电图呈典型SⅠ QⅢ TⅢ,30%有肺动脉高压;CTPA的诊断敏感性为77.3%.病死率为10%.结论:下肢深静脉血栓形成是肺栓塞最多见诱因;综合临床表现及时诊治,可降低肺栓塞病死率.     

老年肺血栓栓塞症患者血流动力学的变化及影响因素

目的探讨老年肺血栓栓塞症患者血流动力学的变化及影响因素。方法选择70岁以上老年肺血栓栓塞症患者100例作为肺血栓栓塞症组,70岁以上老年健康体检者100例作为对照组。肺血栓栓塞症组患者根据是否合并肺动脉高压分为肺动脉高压组(59例)和非肺动脉高压组(41例)。收集患者的临床资料及平均动脉压(MAP)、心脏指数(CI)、每搏输出量(CO)、每搏指数、心率、胸腔静脉血压、体血管阻力、肺血管阻力等血流动力学指标。结果肺血栓栓塞症组MAP、CI、CO、每搏指数明显均明显低于对照组(P<0.05),肺血栓栓塞症组心率、胸腔静脉血压、体血管阻力、肺血管阻力均明显高于对照组(P<0.05)。肺动脉高压组年龄明显高于非肺动脉高压组,血小板计数低于非肺动脉高压组,女性、晕厥、V1~3 T波倒置比例明显高于非肺动脉高压组;肺动脉高压组吸烟、高血压、脑卒中、癌症、外伤或手术、呼吸困难、胸膜炎性胸痛、咯血、胸闷、心悸、咳嗽、D-二聚体、右束支传导阻滞、深静脉血栓形成的比例与非肺动脉高压组比较均无统计学差异(P>0.05)。Logistic多因素回归分析结果显示:性别和年龄是肺血栓栓塞症合并肺动脉高压的独立危险因素(P<0.05)。结论老年肺血栓栓塞症患者存在血流动力学改变,性别和年龄是老年肺血栓栓塞症合并肺动脉高压的独立危险因素。     

肺血栓栓塞症合并胸腔积液临床特征分析

目的分析合并胸腔积液的肺血栓栓塞症患者的临床特征,探讨影响肺血栓栓塞症引起胸腔积液的因素及肺血栓栓塞症患者预后因素。方法收集蚌埠医学院第一附属医院2012年1月至2018年12月期间,参与肺血栓栓塞症全国多中心注册登记研究数据库150例确诊肺血栓栓塞症患者的临床资料,将肺血栓栓塞症患者分为2组:肺血栓栓塞症合并胸腔积液组和无胸腔积液组。回顾性比较两组患者的人口学特征、基础疾病、临床表现及实验室检查结果之间的差异。结果 150例肺血栓栓塞症患者,其中合并胸腔积液患者48例,占32%。与未合并胸腔积液组相比,肺血栓栓塞症合并胸腔积液组更多见于手术或外伤病史后(22%vs. 8%),胸痛(54%vs. 22%)、呼吸困难(65%vs.39%)及发热(8%vs. 1%)的发生率更高,白细胞计数(10.75×109/L vs. 8.56×109/L)、C-反应蛋白(67.45 mg/dL vs.17.21mg/dL)、凝血酶原时间(13.75s vs. 12.20s)均增高明显,差异有显著性意义(P均0.05)。多变量Logistic回归分析显示:C-反应蛋白、胸痛及呼吸困难是肺血栓栓塞症患者合并胸腔积液的独立影响因素(OR值分别为1.011、2.922、2.308,P均0.05)。Kaplan-Meier生存分析显示肺血栓栓塞症患者合并胸腔积液患者的预后不良。多因素Cox风险回归分析得出胸腔积液是肺血栓栓塞症患者预后不良的独立危险因素。结论肺血栓栓塞症合并胸腔积液的发病率较高尤其是术后或外伤后;不明原因的胸腔积液患者,若出现胸痛及呼吸困难,同时C-反应蛋白升高,应高度怀疑肺血栓栓塞症可能,必要时行计算机断层摄影肺动脉造影以明确诊断。胸腔积液为肺血栓栓塞症患者预后不良的独立危险因素。     

不同治疗方法对老年肺血栓栓塞症预后的影响

目的探讨老年肺血栓栓塞症的临床特点、诊断方法、不同治疗方案及其疗效。方法回顾性分析我院2001~2007年确诊为肺血栓栓塞症的48例老年患者的临床资料,根据治疗方法分为溶栓组(10例)、抗凝组(20例)及抗血小板组(18例)。对肺血栓栓塞症的发病诱因、诊断方法和不同治疗方案及疗效进行分析。结果肺血栓栓塞症的临床表现无明显特异性,以呼吸困难及胸痛为主要临床表现,在实验室检查中放射性核素肺灌注通气检查阳性率高,心电图可表现为窦性心动过速,ST-T改变,SⅠQⅢTⅢ征,超声心动图可表现为右心房、右心室增大,三尖瓣反流及肺动脉高压,溶栓组痊愈7例,好转2例,死亡1例;抗凝组痊愈11例,好转9例;抗血小板组痊愈4例,好转7例,死亡7例。溶栓组与抗凝组疗效无统计学差异,溶栓组与抗血小板组及抗凝组与抗血小板组间疗效均有统计学差异(P<0.05)。结论肺血栓栓塞症的临床表现多样,溶栓及抗凝治疗均可有效改善预后,单纯抗血小板治疗效果不佳。     

抗磷脂抗体综合征的分类及临床表现

抗磷脂抗体综合征 (APS)的临床表现主要为 :1动、静脉血栓形成及栓塞 ;2血小板减少 ;3反复自发性流产或死胎。既所谓“三联症”。1.分类根据病因分类 :1原发性抗磷脂血栓综合征 (APL- T) :临床上原因不明的血栓与习惯性流产伴 APA持续阳性者。2继发性 APL- T:原因有 SL E和其他自身免疫性疾病、淋巴增生性疾病、肿瘤、感染 (细菌、病毒、原虫 )、炎症、药物等 ,已如前述。根据抗体分类 :1狼疮抗凝因子血栓综合征 (L A- T综合征 ) :伴 L A持续阳性 ,L A往往引起静脉血栓 (主要为 DVT和 PE) .2抗心磷脂抗体血栓综合征 (ACA- T综…     

肺血栓栓塞症74例诊治分析

目的通过总结肺血栓栓塞症（PTE）患者的临床特征、辅助检查、治疗等,加强对本病的认识和了解。方法收集74例肺血栓栓塞症患者的临床资料,分析其临床表现、实验室检查、治疗与转归的特点。结果74例肺血栓栓塞患者临床表现依次为呼吸困难、胸痛、咯血、咳嗽、低血压、烦躁、濒死感、发热、胸闷、心悸、晕厥。其中表现为典型肺梗死三联征者19例（25．7％）。血气分析PaO2下降67例（90．5％）,血D-二聚体〉500μg／L者55例（74．3％）,心电图异常者67例（90．5％）,CT肺动脉造影阳性者65例（87．8％）,超声心动图提示肺动脉高压51例（68．9％）,下肢血管超声检查提示下肢深静脉血栓49例（66．2％）。平均确诊时间为（3．8±1．7）天,误诊率为33．8％。单纯抗凝治疗58例,有效率为100％;溶栓16例,治愈率为75．0％,死亡率为25．0％。结论肺血栓栓塞症患者临床表现各异,无特异性诊断方法,CT肺动脉造影对肺血栓栓塞症有重要诊断价值,早期诊断,积极抗凝治疗效果好,溶栓治疗应严格掌握适应证。     

肺栓塞的危险因素分析及预防现状

肺栓塞（pulmonary embolism，PE）是以各种栓子阻塞肺动脉或其分支而引起肺循环障碍的临床综合征，其中以肺血栓栓塞症（PTE）最多见。75％-90％病人的栓子来自下肢静脉血栓。肺栓塞是呼吸系统疾病中常见的急症，病死率高达20％-30％。病人均有不同程度的呼吸困难、胸痛、喘憋、咯血、发热等症状。同时由于患者对剧烈的胸痛、严重的呼吸困难、反复抽血、下肢制动、     

急性肺栓塞的研究进展

根据《肺血栓栓塞症诊治与预防指南》关于肺栓塞(pulmonary embolism,PE)的定义,PE是以各种栓子阻塞肺动脉或其分支为其发病原因的一组疾病或临床综合征的总称,包括肺血栓栓塞症(pulmonary thromboembolism,PTE)、脂肪栓塞综合征、羊水栓塞、空气栓塞、肿瘤栓塞等,其中PTE为肺栓塞的最常见类型[1-2]。肺栓塞的临床表现是多种多样的,常见的主要有呼吸困难、胸痛、晕厥及咯血。体征可有呼吸急促、心动过速、肺部哮鸣音和细湿啰音等。     

慢性阻塞性肺疾病急性加重期伴发肺动脉栓塞的发生率及其危险因素分析

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)伴发肺动脉栓塞(PE)的发生率及其危险因素。方法选择我院2015年10月至2016年11月接诊的96例AECOPD患者,按是否伴发肺动脉栓塞分为两组,观察组为26例AECOPD伴发PE患者,对照组为70例AECOPD患者。观察比较两组患者临床特征及检查结果,分析AECOPD伴发PE的发生率及其危险因素。结果两组患者咳嗽、呼吸困难、干湿性罗音及晕厥症状发生率没有较大区别,观察组发热、咯血、胸痛、胸腔积液及不对称下肢水肿症状发生率明显高于对照组,差异有统计学意义(P0.05)。两组患者血小板压积(PCT)没有明显差异,观察组患者Pa O2、Pa CO2较对照组患者明显更低,观察组患者WBC、Hb、肺动脉压、ET-1及D-二聚体(D-D)较对照组患者明显更高,两组差异有统计学意义(P0.05)。观察组长期卧床占65.38%,心功能不全占42.31%,既往肺血栓栓塞症史占26.92%,脑血栓意外占23.08%,恶性肿瘤占19.23%,6周内手术史占15.38%,下肢外伤史占11.54%;对照组长期卧床占14.29%,心功能不全占21.43%,既往肺血栓栓塞症史占2.86%,脑血栓意外占2.86%,恶性肿瘤占5.71%;观察组继发性危险因素发生率均比对照组更高,两组差异有统计学意义(P0.05)。结论 AECOPD伴发PE的发生率较高,长期卧床、心功能不全及既往肺血栓栓塞症史是其主要危险因素。     

肺血栓栓塞症32例误诊病例分析

目的 提高对肺血栓检塞症的认识,减少或避免误诊.方法 对32例肺血栓栓塞症误诊病例的临床资料进行回顾性分析.结果 32例肺血栓栓塞症误诊病例的临床症状以呼吸困难和胸痛居多,体征以心动过速和肺动脉辩听诊区第二心音亢进及发热居多,常规实验室检查以血气呈低氧血症者居多,误诊的疾病多为呼吸系统疾病和心血管系统疾病.结论 肺血栓栓塞症的临床表现、体征及常规检查无特异性,但仍以呼吸困难、胸痛、心动过速、发热、肺动脉辨区第二心音亢进为多,易被误诊为呼吸系疾病和心血管疾病,临床上应加强对肺血栓栓塞症诊断与鉴别诊断意识,避免误诊.     

肺血栓栓塞症54例诊断分析

目的:探讨肺血栓栓塞症(PTE)的临床特点、早期诊断方法,提高PTE的诊断率.方法:回顾分析2000-01-2010-08我院收治的54例PTE患者的临床表现、实验室辅助检查结果及治疗方法等资料.结果:PTE的临床表现缺乏特异性,主要表现为呼吸困难(57.4%)、胸痛(46.3%)、咯血(22.2%)及咳嗽(31.5%...     

不同年龄段患肺血栓栓塞症的危险因素及临床特征比较

目的探讨不同年龄段肺血栓栓塞症(PTE)临床特征的差异,提高对各年龄组人群PTE的认识。方法对广州医学院第一附属医院广州呼吸疾病研究所1997年8月至2006年4月确诊为急性PTE的105例患者(其中年龄≥60岁组57例,<60岁组48例)的临床资料进行回顾性分析,比较两年龄段PTE的危险因素及临床特征的差异。结果(1)危险因素:<60岁组PTE的发病危险因素较≥60岁组少。静脉炎在两组均是最常见的危险因素。<60岁组PTE患者常见的危险因素还包括静脉注射毒品、家族性易栓症等;而慢性阻塞性肺疾病(COPD)、长期制动、恶性肿瘤、心脏病等危险因素更常见于≥60岁组的PTE患者。(2)临床症状:胸痛和咯血在<60岁组中相对多见,三联征(即同时具有呼吸困难、胸痛和咯血症状)更常见于<60岁组;而晕厥则常发生于≥60岁组的PTE患者。≥60岁组更易发生大面积PTE。(3)实验室改变:<60岁组动脉血氧分压(PaO2)平均绝对值高于≥60岁组,PaO2相对百分比在两组间差异无显著性意义。两组肌钙蛋白阴性的PTE患者出现严重并发症几率明显低于肌钙蛋白阳性者。结论≥60岁的PTE患者危险因素多,临床表现可能不典型,且更易出现大面积PTE;<60岁的PTE患者临床症状可相对典型。心肌肌钙蛋白可作为PTE预后的评估指标。     

原发性肺动脉肉瘤误诊误治原因分析

目的 提高对原发性肺动脉肉瘤的认识,减少误诊、误治.方法 结合北京安贞医院2001年10月至2009年3月手术病理证实的4例原发性肺动脉肉瘤患者的的临床资料和国外有关文献,对原发性肺动脉肉瘤的误诊、误治原因进行分析.结果 原发性肺动脉肉瘤的临床表现和肺血栓栓塞症相似,主要有活动性呼吸困难/气促、胸闷、胸痛、咳嗽、咯血、晕厥等,无特异性;彩色多普勒超声心动图显示右心扩大,三尖瓣返流.肺动脉高压,右室流出道及主肺动脉内团块样异常回声;多普勒血管超声显示下肢静脉正常;CT肺动脉造影显示肺动脉扩张,管腔狭窄,主肺动脉及左、右肺动脉内大块充盈缺损等.4例患者术前全部误诊为肺栓塞,给予溶栓抗凝治疗,疗效不佳.手术后死亡1例,3例存活者病情缓解,无一例辅助放疗和(或)化疗.结论 原发性肺动脉肉瘤临床上少见,易误诊为肺栓塞给予溶栓抗凝治疗,确诊需手术,手术为主的综合治疗是治疗此病的有效手段.     

An autopsy case of chronic thromboembolic pulmonary hypertension with long-term progressive dyspnea]

A 71-year-old man who had been suffering from slowly progressive dyspnea on exertion for 16 years was admitted because of hemoptysis and severe dyspnea in 1997. His medical history included respiratory failure in 1986. At that time, chest X-ray films showed cardiomegaly and striking enlargement of hilar pulmonary arteries, while a lung perfusion scan revealed segmental defects. A diagnosis of chronic thromboembolic pulmonary hypertension (CTPH) was made on the basis of multiple filling defects detected by pulmonary angiography and marked pulmonary hypertension (104/29 mmHg) measured by right heart catheterization. The patient died unexpectedly 1 month later. Autopsy revealed a large new thrombotic lesion straddling the organizing thrombotic lesion in the right pulmonary artery. It is important to keep CTPH in mind when examining and treating patients with unexplained dyspnea. In this respect, our case was considered of value to an understanding of the natural course of CTPH.     

Chest radiographs in acute pulmonary embolism. Results from the International Cooperative Pulmonary Embolism Registry

OBJECTIVES: To characterize chest radiographic interpretations in a large population of patients who have received a diagnosis of acute pulmonary embolism and to estimate the sensitivity and specificity of chest radiographic abnormalities for right ventricular hypokinesis that has been diagnosed by echocardiography. DESIGN: A prospective observational study at 52 hospitals in seven countries. PATIENTS: A total of 2,454 consecutive patients who had received a diagnosis of acute pulmonary embolism between January 1995 and November 1996. RESULTS: Chest radiographs were available for 2,322 patients (95%). The most common chest radiographic interpretations were cardiac enlargement (27%), normal (24%), pleural effusion (23%), elevated hemidiaphragm (20%), pulmonary artery enlargement (19%), atelectasis (18%), and parenchymal pulmonary infiltrates (17%). The results of chest radiographs were abnormal for 509 of 655 patients (78%) who had undergone a major surgical procedure within 2 months of the diagnosis of pulmonary embolism: normal results for chest radiograph often accompanied pulmonary embolism after genitourinary procedures (37%), orthopedic surgery (29%), or gynecologic surgery (28%), whereas they rarely accompanied pulmonary emboli associated with thoracic procedures (4%). Chest radiographs were interpreted to show cardiac enlargement for 149 of 309 patients with right ventricular hypokinesis that was detected by echocardiography (sensitivity, 0.48) and for 178 of 485 patients without right ventricular hypokinesis (specificity, 0.63). Chest radiographs were interpreted to show pulmonary artery enlargement for 118 of 309 patients with right ventricular hypokinesis (sensitivity, 0.38) and for 117 of 483 patients without right ventricular hypokinesis (specificity, 0.76). CONCLUSIONS: Cardiomegaly is the most common chest radiographic abnormality associated with acute pulmonary embolism. Neither pulmonary artery enlargement nor cardiomegaly appears sensitive or specific for the echocardiographic finding of right ventricular hypokinesis, an important predictor of mortality associated with acute pulmonary embolism.     

原发性肺动脉肉瘤11例临床分析

目的提高对原发性肺动脉肉瘤(PAS)的认识和早期诊治水平。方法手术病理证实的原发性肺动脉肉瘤11例,对其临床资料进行回顾性分析。结果(1)11例患者中,男4例,女7例,平均年龄44.3±9.1岁。(2)临床主要表现有活动性呼吸困难、胸痛、咳嗽、咯血、晕厥等。(3)超声心动图显示右心室扩大、肺动脉高压、右室流出道及主肺动脉内占位性病变,下肢静脉超声正常。(4)CT肺动脉造影(CTPA)表现为肺动脉扩张、主肺动脉及左、右肺动脉内肿块样阴影等。(5)11例患者术前全部被误诊,多数被误诊为肺血栓栓塞症(PTE)。(6)11例患者中10例行手术切除治疗,9例缓解出院,1例死亡;另1例内科治疗死亡。结论PAS临床上少见,易误诊为PTE。临床医师应提高认识,以早期诊断和综合治疗此病。     

36例肺血栓栓塞症临床分析

目的 探讨肺血栓栓塞症的临床特点、诊断方法、治疗措施和治疗效果.方法 对2005～ 2010年我院收治的36例PTE患者进行临床分析.结果 肺血栓栓塞症的患者中以呼吸困难最为常见,32例(89％).34例经CT肺动脉造影明确诊断,积极溶栓及抗凝治疗后症状改善.结论 CT肺动脉造影可帮助肺血栓栓塞症诊断,及时规范的溶栓及抗凝治疗效果肯定.     

Preliminary criteria for the diagnosis of pulmonary hypertension in mixed connective tissue disease

Based on analysis of data obtained from multicenter patients with collagen diseases (83 with pulmonary hypertension(PH) and 472 without PH), preliminary criteria for the diagnosis of PH in mixed connective tissue disease (MCTD) were proposed by the Research Committee for MCTD of the Ministry of Health and Welfare of Japan. The diagnosis of PH requires four or more out of six clinical and laboratory findings, including exertional dyspnea, systolic pulsation on the left sternum, increased 2nd pulmonary sound, dilatation of the pulmonary artery on chest X-ray, right ventricular hypertrophy on the electrocardiogram, and right ventricular enlargement on the echocardiogram. Alternatively, either an increase of mean pulmonary artery pressure over 25 mmHg measured by right ventricle catheterization, or the corresponding finding on Doppler echocardiography is also valid for the diagnosis of PH. When these criteria were applied to the patients in this study, the sensitivity was 92% and the specificity 100%, showing that PH may be adequately diagnosed using non-invasive methods. The number of criteria satisfied by patients with PH was well correlated with their mean pulmonary artery pressure measured by heart catheterization.     

老年人肺血栓栓塞症的临床表现与分析

目的评价老年人肺血栓栓塞症(PTE)的临床表现。方法采用前瞻性描述性研究方法,将明确诊断为PTE的525例患者分为老年组(≥60岁,226例)和非老年组(<60岁,299例),进行临床表现分析,分别计算其两组的发生率。结果老年组常合并多种疾病,其中以心脑血管疾病为主。老年组胸膜性胸痛(35.8%)及咯血(17.3%)的发生率较非老年组低。老年组和非老年组下肢深静脉血栓形成(DVT)的检出率相同。结论老年PTE患者合并疾病多,临床表现更不典型,需提高对老年PTE的诊断意识。     

Unilateral absence of the pulmonary artery incidentally found after an episode of hemoptysis

A 29-year-old woman was admitted to our hospital because of hemoptysis and dyspnea. A chest radiographic study revealed an enlargement of the right lung hilum, and the left pulmonary artery could not be clearly visualized on contrast-enhanced CT scan. Both perfusion scintigraphy and pulmonary angiography confirmed the absence of the left pulmonary artery, and agenesis of the right upper pulmonary artery. Her clinical status has been stable for the previous two years of follow-up, even though she required long-term oxygen therapy. This is a rare case of a young woman with the unilateral absence of the left pulmonary artery incidentally found after an episode of hemoptysis.