急性肺栓塞34例危险因素及临床分析

目的探讨急性肺栓塞（APE）危险因素与发病的关系,提高APE诊治水平。方法对34例确诊为APE患者的易患因素、临床表现、辅助检查、治疗方法进行回顾性分析。结果患者常有多种危险因子,34例患者中有溶栓适应证9例,其中有2例在心肺复苏时溶栓,均死亡,1例死于溶栓后上消化道大出血;单纯行抗凝治疗21例,死亡4例;抗凝＋下腔静脉滤器置入1例;因有抗凝、溶栓禁忌3例,仅对症、支持处理均死亡。共死亡10例,病死率为29.41%。24例存活（6例溶栓,17例单纯抗凝,1例抗凝＋下腔静脉滤器置入治疗）。结论APE的发病与易患因素密切相关,CT肺动脉造影（CTPA）已作为确诊检查的首选方法,溶栓治疗能提高APE患者的存活率。

Risk factors and clinical analysis of thirty four patients with acute pulmonary embolism

Objective To investigate the relationship between the risk factors and onset of acute pulmonary embolism and to develop a proper diagnostic strategy and clinical management for patients with acute pulmonary embolism.Methods Predisposing factors,clinical manifestation,treatment and outcomes of 34 consecutive patients with established acute pulmonary embolism were analyzed retrospectively.The patients were definitely diagnosed in our hospital from 2005 to 2013.Results The patients with APE often had one or more risk factors.Indications of 34 cases with thrombolysis 9 cases,including 2 cases during cardiopulmonary resuscitation（CPR）thrombolysis,died,1 case died of upper gastrointestinal bleeding after thrombolysis;Simple lines of anticoagulant treatment of 21 cases,4 cases died;Anticoagulation ＋ inferior vena cava filter placement in 1 case;Because of anticoagulation,thrombolysis,taboo in 3,only symptomatic support,dealing with death.10 cases,death rate of 29.41%.24 patients survived（6 cases of thrombolysis,17 cases of pure anticoagulation,1 case of anticoagulant treatment ＋ inferior vena cava filter placement.Conclusion The incidence of acute pulmonary embolism is closely related to the associated factors.CTPA has confirmed as the preferred method of inspection.