急性肺栓塞的早期诊断及治疗

目的探讨急性肺动脉栓塞的临床特点,早期诊断并积极干预治疗,降低临床死亡率和致残率。方法回顾性分析100例急性肺动脉栓塞患者的临床资料,对易患因素、症状、体征、实验室检查、心电图检查和影像学资料、危险分层、治疗和预后进行分析。结果早期急性肺动脉栓塞临床表现中呼吸困难93.0%、肺动脉高压57.0%、晕厥16%最常见;高危患者占20%,中危者占33%,低危占47%;治疗上,低分子肝素和华法林抗凝者90例,占90%;尿激酶溶栓者7例,占7%;介入碎栓2例(2%);手术取栓1例(1%),治疗好转86例86%,死亡14例(14%)。结论呼吸困难、肺动脉高压和晕厥是急性肺动脉栓塞主要表现,结合D二聚体、B超、CT等影像学检查可提高早期诊断率;根据危险分层,采取溶栓或抗凝治疗,是目前治疗肺动脉栓塞的主要措施。

Diagnosis and treatment of acute pulmonary thromboembolism

Objective To analyze the clinical characteristics of the acute pulmonary thromboembolism （APTE） and diagnose and treat the APTE in the early stage in order to lower the mortality and mutilation rate. Methods Clinical data of 100 APTE were retrospectively analyzed, including the liability factor, symptoms, signs, laboratory examination, electrocardiogram examination, imageology data, risk stratification, treatment as well as prognosis. Results The clinical manifestation in the early stage of APTE including dyspnea（93% ）, pulmonary hypertension（57% ）, and syncope（ 16% ）, which were the main manifestation. Patients with high risk accounted for 20% , middle risk for 33% ,while low risk for 47%. Ninety patients were treated with low molecular heparin and warfarin（90% ） ; 7 patients were treated with urodinase for thrombolysis （7%） ; 2 patients were treated with percutaneous catheter embolectomy and fragmentation （2%） ; 1 was treated with surgical pulmonary embolectomy. 84% of these patients were getting better, while 14% were dead. Conclusion Dyspnea, pulmonary hypertension and syncope are the main manifestations of APTE. Combined with D -dimer, B -ultrasound, CT imageology data, and so on, the early diagnostic rate can be increased. Thrombolysis and anticoagulation are the main therapeutic strategies according to the risk stratification.