50例老年人急性肺栓塞临床特点分析

目的 探讨如何提高对老年人肺栓塞的诊断率和减少漏诊率.方法 对50例确诊的老年急性肺栓塞患者的易患因素、临床特点、辅助检查、治疗方法及转归进行临床评估分析.结果 50例肺栓塞患者中,主要临床表现为呼吸困难者为92%、咳嗽为56%、心悸为50%、胸痛为46%;血气分析示低氧血症者占94%;D-二聚体＞500μg/L者占90%;螺旋CT肺动脉造影（CTPA）为主要诊断方法;接受溶栓治疗19例,单纯抗凝治疗29例,2例因出血未行任何抗凝治疗.17例行下腔静脉滤器植入术以预防再次肺栓塞.治愈5例（均为溶栓患者）,占10%;好转43例,占86%;死亡2例（均为单纯抗凝治疗患者）,占4%.结论 肺栓塞临床表现多样;X线胸片、心电图等常规检查不具特异性;D-二聚体具有筛选价值;CTPA是首选的诊断方法,必要时可以做核素肺通气灌注显像和肺动脉造影;老年肺栓塞患者溶栓治疗时出血风险较高.

Clinical characteristics of acute pulmonary embolism in 50 elderly patients

Objective To investigate the risk factors, the clinical assessment, and to develop a proper diagnostic strategy and clinical management for the elderly patients with pulmonary embolism. Methods The predisposing factors, clinical assessment, treatment and outcomes of 50 consecutive elderly patients with established acute pulmonary embolism were analyzed retrospectively. Results 92% had dyspnea, 56% had cough, 50% had palpitation, 46% had chest pain, 94% had hypoxemia, 90% had D-Dimer>500 ng/ml. Spiral-CT pulmonary arteriography(CTPA) was the main diagnostic method. Nineteen patients received thrombolytic therapy, Twenty-nine patients received anticoagulative therapy, 2 patients didn't receive any therapy because of bleeding. Five(10%) patients were cured, 43 (86%) patients got better, 2(4%) patients were dead. Conclusions The clinical manifestations of pulmonary embolism in the elderly were varied. CTPA is the main diagnostic method and ventilation-perfusion lung scan or pulmonary angiography can be done when it is necessary. Thrombolytic treatment can improve the survival rate of patients with acute pulmonary embolism.