肺栓塞并胸腔积液的相关临床分析

目的探讨肺栓塞(Pulmonary Embolism,PE)并胸腔积液患者的临床特点。方法对确诊的115例肺栓塞患者,根据患者是否存在胸腔积液分为肺栓塞并胸腔积液组(实验组)及肺栓塞无胸腔积液组(对照组),比较两组的临床特点。结果合并胸腔积液有52例,无胸腔积液有63例。肺栓塞并胸腔积液患者的发热比率、呼吸次数、PT、APTT、FIB、INR、DD、HSCRP、cTnT、NTproBNP、RAD及mPAP高于无胸腔积液患者,差异有统计学意义(P<0.05);肺栓塞并胸腔积液患者的LYMPH、AT水平低于无胸腔积液患者,差异有统计学意义(P<0.05);经多因素logistic回归分析,FIB、DD、RAD及AT可能是PE发生胸腔积液独立预测因子,FIB、DD及RAD可能是PE患者发生胸腔积液的危险因素,AT可能为PE发生胸腔积液的保护因素。52例肺栓塞合并胸腔积液患者中,双侧胸腔积液33例(63.5%),单侧胸腔积液19例(36.5%);少量胸腔积液44例(84.6%),中-大量胸腔积液8例(15.4%);双侧少量胸腔积液29例(55.77%)。肺栓塞栓塞部位与是否发生胸腔积液比较,差异无统计学意义(P>0.05)。在肺栓塞并胸腔积液组中,肺栓塞栓塞部位与胸腔积液部位比较,差异无统计学意义(P>0.05);肺栓塞栓塞部位与胸腔积液量比较,差异无统计学意义(P>0.05);胸腔积液部位与胸腔积液量比较,差异无统计学意义(P>0.05)。肺栓塞并胸腔积液组不良事件发生率高于肺栓塞无胸腔积液组,差异有统计学意义(P<0.05)。结论FIB、DD、RAD及AT可能是PE发生胸腔积液的影响因素。肺栓塞并胸腔积液多为双侧少量胸腔积液。肺栓塞部位、胸腔积液量及胸腔积液部位之间未发现有相关性。胸腔积液对PE患者短期预后的评估具有一定价值。     

急性肺动脉栓塞7例临床分析

目的:分析急性肺动脉栓塞(APE)的临床特点、早期诊断的无创检查手段、溶栓及抗凝治疗的疗效,以期降低漏诊率和误诊率,并探讨其早期诊断及治疗方法,以提高患者的存活率及生活质量。方法:回顾性分析2008年3月至2009年1月我院住院的7例APE的临床特点、辅助检查和治疗方案等临床资料。结果:APE的临床表现以呼吸困难最为常见;D-二聚体对APE具有高度敏感性;64排CT肺动脉造影(CTPA)+心脏彩超等检查可明确诊断APE。积极予以溶栓抗凝治疗可降低病死率。结论:APE临床症状多样,临床医生应高度警惕。D-二聚体可作为APE筛选检查;64排CTPA是诊断APE的极为有效方法;及时规范的溶栓抗凝疗法在APE治疗中疗效肯定,副作用少。     

肺栓塞患者危险因素及临床特征分析

目的总结肺栓塞患者的危险因素和临床特征。方法分析37例肺栓塞的危险因素、临床特征、诊治经过及预后。结果37例肺栓塞中,手术科室发生15例（40．5％）,非手术科室发生22例（59．5％）。13．5％患者有呼吸困难、胸痛、咯血三联征,13．5％心电图有SⅠQⅢTⅢ表现,21．6％有肺动脉高压,8．1％肺栓塞患者最终死亡。手术科室肺栓塞患者Kaprini评分和SⅠQⅢTⅢ比例显著高于非手术科室,但两组在临床症状、体征和预后上无统计学差异。住院期间病死率为8．1％,1年内病死率13．5％。结论住院患者是肺栓塞的高危人群,病死率高。恰当的风险评分、预防、早期发现和治疗可能是减少其病死率和致死率的有效方法。     

肺栓塞诊断方法的应用

肺栓塞患者的临床症状、体征表现多样,根据其早期死亡风险分为高危和非高危患者,对可疑高危患者应首选超声心动图检查,可疑非高危患者CT肺血管造影是首选的确诊方法。还需结合血浆D-二聚体测定、外周血管超声、肺通气/灌注扫描、CT肺动脉造影检查等侵袭性或非侵袭性的检查方法明确诊断,一些其他实验室检查指标、心电图、动脉血气分析、胸部平片等检查对PE诊断也具有一定价值。     

CT肺栓塞指数在肺栓塞患者中的临床应用研究

目的:探讨肺栓塞指数(CTI)在肺栓塞(PE)患者中的临床应用价值。方法:入选通过双源CT肺动脉造影确诊的187例PE患者,132例为急性PE,55例为慢性PE;急性PE中,低危组46例,中危组86例,高危组0例。通过CT影像计算CTI,结合PE危险分层绘制两者的受试者工作曲线(ROC曲线)并得到最佳诊断阈值,按对应的CTI将急、慢性PE患者分别划分为2组,对比分析2组的临床病例资料。结果:1急性PE中,低危组平均CTI为(37.5±27.4)%,中危组平均CTI为(50.8±23.9)%,差异具有统计学意义(P0.05);慢性PE平均CTI为(23.1±21.9)%。2CTI与危险分层的ROC曲线下面积为0.653(P=0.004),最佳诊断阈值对应的CTI为60%。3急、慢性PE患者CTI在性别、年龄分布上的差异均无统计学意义。4急性PE中,与CTI60%组相比,CTI≥60%组出现呼吸困难及晕厥症状比例更多,心率更快,PaO_2、SaO_2、PaCO_2降低,P(A-a)O_2增高,WBC、NEUT、Hs CRP增高,cTnI、BNP、D-二聚体增高,RA、RV、RV/LV增高(均P0.05)。2组在收缩压、舒张压方面差异无统计学意义。5慢性PE中,与CTI60%组相比,CTI≥60%组出现呼吸困难症状比例更多,PaO_2、SaO_2、PaCO_2降低,P(A-a)O_2增高,HsCRP、D-二聚体增高,RA、RV、RV/LV增高。急性、慢性PE中,CTI≥60%组的肺栓塞严重指数(PESI)评分均高于CTI60%组(P0.05)。结论:CTI与PE危险分层具有显著的相关性,两者ROC曲线的最佳诊断阈值所对应的CTI为60%。以60%为界,CTI可良好区分急、慢性PE患者的病情严重程度及预后,说明CTI在急、慢性PE患者中均具有一定的临床应用价值。     

D-二聚体阴性急性肺血栓栓塞症患者临床分析

目的探讨急性肺栓塞(PE)患者D-二聚体检测阴性的影响因素。方法回顾性分析2012年1月至2015年12月明确诊断为PE的住院患者的病例特点,比较10例D-二聚体阴性与103例D-二聚体阳性PE患者的性别、年龄、发病到就诊时间、高危因素、临床表现、D-二聚体值、经螺旋CT肺动脉造影(CTPA)检查栓子栓塞部位的差异。结果两组性别、年龄、高危因素、临床表现方面无统计学差异(P>0.05);两组发病到就诊时间比较虽无统计学差异(P>0.05),但阴性组略长于阳性组。两组CTPA所示,阴性组段以下肺动脉栓塞的比例高于阳性组;而左右肺动脉及段以上肺动脉栓塞的比例低于阳性组(P<0.05)。结论急性PE患者D-二聚体检测阴性可能与发病到就诊时间较长、血栓阻塞部位较远或血栓较小有关。     

肺动脉栓塞21例临床分析

目的探讨肺栓塞的临床特点、诊断方法和治疗措施及预后。方法对我院2006—2008年收治的急性肺栓塞患者21例进行临床分析。结果21例急性肺栓塞患者,出现气急17例,咯血4例,发热5例,胸痛8例,晕厥3例。20例经肺增强CT或CT肺动脉造影明确诊断,1例为临床诊断。结论肺栓塞临床表现多样,诊断需结合易患因素,CT肺动脉造影可帮助明确诊断。     

心源性胸腔积液 28 例临床分析

目的探讨心力衰竭(心衰)引起的胸腔积液的临床特点及诊治方法。方法对28例心力衰竭引起胸腔积液病人的临床资料进行回顾性分析。结果双侧胸腔积液17例占60.71%,右侧8例占28.57%,左侧3例占10.71%;小量积液16例占57.14%,中量积液10例占35.71%,大量积液2例占7.14%。胸水化验:12例抽取胸水进行化验,漏出液8例占66.67%,渗出液3例占25%,介于渗出液和漏出液间1例占8.33%。16例小量积液病人经抗心衰治疗后胸水1周内明显吸收,12例中、大量胸水则需配合胸腔引流。结论心衰引起的胸腔积液多为双侧,单侧则以右侧多见。胸水量以少量多见,多数呈漏出液,抗心衰治疗后可明显吸收。     

胸腔积液386例临床分析

目的探讨胸腔积液的病因分布及诊治特点。方法回顾性分析386例胸腔积液的临床资料。结果通过典型临床表现、影像学检查、胸液及血清学实验室检查、胸膜活检或通过临床治疗明显好转、随诊1—3个月后确诊良性胸液244例，其中结核性175例（71．7％），肺炎26例（10．7％），肺梗塞16例（6．6％），心功能不全11例（4．5％），其他16例。恶性138例，其中原发性肺癌99例，乳腺癌11例，淋巴瘤8例，其他20例。不明原因者4例。结论结核和肿瘤是导致胸腔积液的主要原因，能否尽快鉴别二者直接影响其治疗和预后。     

Pleural effusion in patients with pulmonary embolism

Background and objective: It has been suggested that pulmonary embolism (PE) is an under‐recognized cause of pleural effusion. This study aimed to (i) establish the incidence and clinical relevance of pleural effusion in patients with pulmonary emboli; and (ii) determine if there is a relationship between development of pleural effusions and the location of emboli and number of pulmonary arteries involved. Methods: A retrospective analysis of all CT pulmonary angiograms (CTPA) performed over 12 months on adult patients with clinically suspected PE in a hospital which used CTPA as first‐line imaging investigation for PE. Results: Of 285 CTPA, 60 patients (21%) had evidence of pulmonary emboli (38 had both central and peripheral clots and 22 peripheral emboli only). Emboli were bilateral in 39 cases and unilateral in 21 cases. Pleural effusion was present in almost one half (n = 29, 48%) of the patients with pulmonary emboli. Patients with pulmonary emboli were more likely to have a pleural effusion (OR 2.2 (95% CI: 1.1–4.7), P < 0.05) than patients without PE; however, the effusions were generally very small. Most (86%) of the effusions were present on the same side as the emboli. The location of emboli and number of arteries involved did not predict the presence of pleural effusions. Conclusions: Pleural effusion is common in patients with pulmonary emboli demonstrated on CTPA. These effusions are small and seldom alter clinical management. Clinicians should therefore have a high threshold of suspicion in attributing large or contralateral pleural effusions to embolic diseases without excluding alternative diagnoses.     

Prevalence and clinical significance of pleural effusion in patients with acute pulmonary embolism: a retrospective study

BackgroundPleural effusion is observed in a subset of patients with acute pulmonary embolism (APE) and may be linked to clinical outcome, but findings from previous studies have been inconsistent. This study aimed to investigate the prevalence and clinical significance of pleural effusion in Chinese patients with APE.MethodsClinical data from hospitalized patients with APE were retrospectively collected and the prevalence of pleural effusion was determined. The relationship between the presence of pleural effusion and clinical outcome of APE was analyzed by Cox proportional hazards regression and Kaplan-Meier survival analysis.ResultsThe study enrolled 635 patients with APE. The prevalence of pleural effusion was 57.01% (362/635). Patients with pleural effusion had significantly higher in-hospital mortality (9.9% vs. 4.8%, P<0.05) and longer length of hospital stay (LOS) (19.99 vs. 15.31 days, P<0.05) than whose without pleural effusion. However, pleural effusion was not an independent risk factor for in-hospital mortality in patients with APE by multivariate Cox proportional hazards regression analysis [hazard ratio (HR) =1.70, 95% confidence interval (CI): 0.73–3.92, P=0.216] and Kaplan–Meier survival analysis (P=0.174).ConclusionsPleural effusion is a frequent occurrence in patients with APE and therefore merits greater attention from clinicians; however, it is not an independent risk factor for in-hospital mortality.     

恶性胸膜间皮瘤合并肺结核/结核性胸腔积液的临床特征分析

目的:分析恶性胸膜间皮瘤(MPM)合并肺结核/结核性胸腔积液(TPE)患者的临床特征,以加强对该类疾病的认识,减少误诊误治。方法:收集首都医科大学附属北京胸科医院2012年2月至2020年2月MPM并肺结核/TPE患者病例资料14例,回顾性分析其临床症状、体征、实验室检查,胸部影像特征等,以总结其特点。结果:剧烈且进行...     

16层螺旋CT肺动脉造影对肺栓塞诊断的应用价值

目的探讨16层螺旋CT在肺动脉栓塞中临床应用价值。方法选择肺动脉栓塞患者36例,所有患者均接受胸部CT及肺动脉造影检查,分析16排螺旋CT对肺动脉显影及肺栓塞显示情况,观察肺动脉栓子的类型、分布和数量。结果1.16排螺旋CT共显示肺动脉干、左/右肺动脉、肺叶、段、亚段及以下动脉1787支,肺动脉栓塞429支,栓塞率为24.01%,其中肺叶动脉比例最高,为38.79%,肺动脉干比例最低,为7.50%。在肺动脉栓塞栓子类型方面,Ⅱ型栓子数量最多,为202处,其次为Ⅳ型,共118处,Ⅲ型数量最少,为31处。其直接征象为充盈缺损,间接征象包括肺纹理稀疏、肺梗死、westemark征及肺动脉高压、胸腔积液、心包积液及胸膜增厚等。结论 16排螺旋CT能够清晰显示肺动脉栓塞的特点,在其诊断和鉴别诊断中具有较高的应用价值。     

肺结节病合并胸腔积液14例诊治分析

目的对肺结节病合并胸腔积液的诊治进行分析。方法对我院1991~2009年间,肺结节病合并胸腔积液的14例患者进行分析。结果 8例为Ⅱ期,6例为Ⅰ期。13例口服醋酸泼尼松片（0.5 mg/kg）逐渐减量治疗。3例曾联合抗结核治疗。口服激素1个月后,4例胸腔积液消失,4例明显减少,3个月后14例患者胸腔积液均消失,1例留有胸膜肥厚。结论肺结节病出现胸腔积液的机制不明,激素治疗剂量与无胸腔积液患者用量相同,逐渐减量。     

16层螺旋CT肺动脉造影对肺栓塞诊断价值

目的探讨16层螺旋CT肺动脉造影对肺栓塞的诊断价值。方法分析55例肺栓塞病例,观察16层螺旋CT对肺动脉显影以及肺栓塞的显示情况。结果 55例患者肺部动脉及分支管腔中共发现栓子380个,栓塞率达24.4%,其中肺动脉干栓子4个,栓塞率7.3%;叶肺动脉栓子105个,栓塞率32.3%。其中中心型栓子69个,比例为18.2%;完全堵塞型栓子54个,比例为14.2%;偏心型栓子最多,为195个,比例为51.3%;附壁型栓子62个,比例为16.3%。结论 16层螺旋CT肺动脉造影能高分辨率地显示肺部动脉管腔对肺部腔内栓子进行精确定位和有效评价。     

Pulmonary anisakiasis presenting as eosinophilic pleural effusion

A 63-year-old man developed a pleural effusion with marked eosinophilia, which was more prominent in the pleural fluid than in the peripheral blood. The pleural effusion spontaneously disappeared 7 days after admission. A multiple dot enzyme-linked immunosorbent assay for anisakiasis was strongly positive for both the serum and pleural fluid. The serum IgG titre for Anisakis simplex gradually decreased over 7 months. It is suspected that Anisakis larvae can penetrate the alimentary canal, and then migrate into the pleural cavity through the diaphragm. Screening with a serological test is useful in the diagnosis of this condition; human pulmonary anisakiasis.