50例肺血栓栓塞临床病理分析

为进一步了解肺血栓栓塞（PTE）的临床特征，提高早期诊断率，收集1982年11月－2001年尸检诊断PTE50例，分析其临床及病理特点。结果显示，PTE以老年患者居多，基础疾病以心血管疾病及恶性肿瘤最常见，其他有肺炎、慢性阻塞性肺疾病、糖尿病、手术和创伤等。临床表现不典型，多表现为呼吸困难突然出现或加重、晕厥、猝死和低氧血症等，具有典型“三联征”者极少。病理特点为巨大肺栓塞23例，次巨大肺栓塞27例，其中13例猝死，肺梗死11例。生产正确诊断8例。误诊原因为临床医师对PTE的临床特点认识不足、警惕性低。提示应对可疑PTE的病人应尽快行临床可能性评估分析并进一步合理安排各项检查以利诊断与治疗。

CLINICAL PATHOLOGICAL STUDY ON 50 CASES OF PULVONARY THROMBOEMBOLISM PROVED BY AUTOPSY

To improve the early diagnosis of pulmonary embolism(PE), clinical and pathological data of 50 cases of pulmonary thromboembolism(PTE) proved by autopsy in General Hospital of PLA from 1982 to 2001 were reviewed. The results showed that in these 50 patients(male 37,female 13) only eight had been diagnosed PE prior to death. The most frequently seen symptoms included sudden onset of dyspnea, syncope and sudden death. The most important causes of incorrect diagnosis were failure to suspect PE, and the protean nature of the disease. It is suggested that all patients with suspected PE have to instantly access the likelihood of PE, and then be sent for further investigations to prove or exclude PE, accordingly, underdetection of PE and mortality of PE could be reduced.