31例肺栓塞误诊原因及不同治疗方法效果的分析

目的 :分析肺栓塞诊断方法及误诊、误治后果 ,观察肺栓塞溶栓和 或抗凝疗法的治疗效果。方法 :据首发症状、初步诊断、辅助检查等分析误诊原因 ,31例肺栓塞分别采用尿激酶溶栓、肝素抗凝治疗及对症治疗。结果 :9例用尿激酶溶栓 +抗凝治疗者治愈 2例 ,显效 2例 ,好转 4例 ,无效 1例 ,总有效率 88 9% ;8例单纯抗凝治疗者治愈 1例 ,显效 1例 ,好转 4例 ,无效 2例 ,总有效率 75 % ;对症治疗组 14例 ,仅好转 3例 ,无效 11例 ,总有效率为 2 1 4%。溶栓及抗凝治疗中未见严重出血及其他副作用。结论 :急性肺栓塞患者早期使用尿激酶进行溶栓治疗可取得较好的临床疗效。延误诊断与病死率呈正相关。早期诊断正确治疗可以减少病死率。

Causes of misdiagnosis and effect of various kinds of therapy in 31 cases of pulmonary embolism

Objective:To analyse the consequence of misdiagnosis and mistherapy of pulmonary thrombotic embolism (PTE)and observe the effect of thrombolytic and anticoagulant therapy.Methods:The reason of misdiagnosis according to the initial symptom,preliminary diagnosis and accessory examinations were analysed.The thirty-one cases of PTE were treated by urokinase,heparin or warfarin or only symptomatic treatment respectively.Results:9 patients treated with urokinase anti cougulant of which 4 had remarkable effect,Four had effect and one had no effect.8 patients treated with heparin or warfarin of which 2 had remarkable effect. Four had effect and two had no effect.The three cases of 14 patients with symptomatic treatment of which 3 had effect,11 had no effect.The total effectual rate of three groups of treat ment were 88 9%,75% and 21 4% respectively;There were no severe bleeding and other adverse effects during thrombolytic and anticoagulant therapy.Conclusion:Urokinase as a thrombolytic therapy at the early stage of the disease has better clinical curative effects.There was positive correlation between delayed diagnosis and mortality.Correct diagnosis at the early stage and prompt thrombolytic and anticoagulant treatment can decrease the mortality.