不同年龄段肺血栓栓塞症患者的临床特征及预后影响因素分析

Objective To explore the clinical characteristics of pulmonary embolism(PE)in different age-groups and to analyze prognostic factors of PE. Methods Data of 209 PE patients diagnosed in our hospihal from 2004 to 2009 were reviewed retrospectively. Results Of the 209 patients with PE,95 subjects (45.5%) were over the age of 65,and 114 were≤65 years.The third leading comorbidity were activity limitation that were banding in bed.chronic obstructive pulmonary disease,neoplasm and hypertension,accounting for 42.1%,24.4% and 21.5%,respectively.The typical clinical presentations included dyspnea(83.7%),cough(74.2%),chest pain(29.2%),haemoptysis(15.3%)and syncope (3.8%).In 186(92.1%)patients,D-dimer wag above the normal level,37.8%(79)and 54.0%(81/150) subjects were found having got a venous thrombosis in lower extremity and pulmonary hypertension,respectively by using ultrasonic visualization.16.7%(35)and 80.9%(169)had received thrombolytic and anticoagulant therapy.respectively.The death rate of PE was 6.7%.A difierence in clinical characteristics wag obserred between younger and older patients.The later had more comorbidity such as COPD.neoplasm and hypertension,the older patients had fewer complaints of chest pain,haemoptysis,fever,hypotension and typical electrocardiogram(ECG),but had more cough with sputum,pulmonary rales and lower extremity edema.in comparison to the younger patients.The older PE patients were less likely to suffer from be thrombosis and pulmonary infarction,and to received thrombolytie therapy. Multivariate logistic regression showed that PaO_2 < 60 mm Hg(1 mm Hg = 0. 133 kPa), having pulmonary rales, having abnormal neutrophilic granulocyte counts, not receiving thrombolysis and anticoagulant therapy, suffering from emergency rescue, having comobidities with tumor and pneumonia were important prognostic factors. Conclusion The clinical features of PE were various and non-specific. More attention should be paid to PE patients, in particular to older patients who usually had more comorbidities and non-specific clinical manifestations.

Clinical characteristics and prognostic factors of pulmonary embolism in different age groups