24例急性致死性肺血栓栓塞患者的分析

目的通过对24例确诊为急性致死性肺血栓栓塞即临床上出现心跳骤停、严重呼吸困难、晕厥、休克等症状或需收入ICU救治的住院患者进行回顾分析,提高对该病的认识和早期诊断治疗,预防猝死。方法回顾性分析24例患者的发病形式、临床表现、实验室及影像学检查包括D-二聚体、动脉血气分析、超声心动图、下肢doppler超声检查或核素检查、肺动脉计算机体层成像(CTPA)、核素肺通气/灌注(V/Q)扫描等结果、治疗方法和预后。结果11例患者急诊溶栓,9例(81.8%)症状得到明显改善,呼吸困难缓解,心率血压维持在正常水平,2例死亡。13例患者单纯抗凝治疗,9例(69.2%)呼吸困难、胸痛、心悸等症状均得到改善,4例自动出院,1例为系统性红斑狼疮晚期,3例为终末期肺部恶性肿瘤患者。结论急性致死性肺栓塞是临床上极为凶险、危及生命的重症,疾病发作快速,表现多样化,早期诊断治疗是预防猝死、改善预后的关键。

An analysis of 24 patients with acute fatal pulmonary thromboembolism

Objective To study the early diagnosis,treatment,and prevention of acute fatal pulmonary thromboembolism(PTE), which is manifested in clinical as severe dyspnea, sudden cardiac arrest, syncope, shock or admitted to ICU. Methods Original pattern, clinical manifestations, lab examinations (such as D-dimer, ABG, echocardiography CTPA and V/Q scan), treatment and prognosis of twenty-four patients diagnosed as acute fatal PTE in Sir Run Run Shaw Hospital from March 2002 to June 2005 were reviewed and analyzed. Results Eleven patients received emergency thrombolytic therapy while the others only received anti-coagulation therapy. In patients who received thrombolytic therapy, nine (81.8%) were alleviated and had good prognosis, two died. In patients who only received anti-coagulation therapy, nine(69.2%) got better in clinical symptoms; four patients were discharged automaticly as terminal of SLE or lung carcinoma. Conclusion Acute fatal PTE is a severe disease that is always threating patients' life and causes sudden death. Early diagnosis and quickly efficient treatment,such as thrombolysis,is key to preventing death and increasing life quality.