肺血栓栓塞症33例临床分析

目的探讨肺血栓栓塞症(PTE)危险因素与发病的关系,提高对肺血栓栓塞症的诊断及治疗水平。方法对2005年12月～2011年9月确诊的33例肺血栓栓塞患者的易患因素、临床表现、辅助检查、治疗方法进行临床回顾分析。结果 PTE患者常有多种危险因子,最常见的临床表现为不明原因的呼吸困难,伴有下肢深静脉血栓形成,其他常见的症状和体征包括呼吸急促、胸痛、晕厥和心动过速等。动脉血气分析、心电图、胸部X线片、超声及D-二聚体试验对PTE诊断有提示作用;CT肺动脉造影是诊断PTE最常用的技术。本组有7例死亡,病死率21.2%,24例患者经溶栓及抗凝治疗后存活。深静脉血栓形成(DVT)是导致PTE的最主要危险因素。结论肺血栓栓塞症的发病率与易患因素密切相关,综合医院临床医师应提高对肺血栓栓塞的警惕性,仔细查找病因,常规X线片、动脉血气分析、心电图、血管超声等均有助于其诊断,但螺旋CT更方便可靠。溶栓治疗能提高PTE患者存活率。

Clinical analysis of 33 patients with pulmonary thrombosis embolism

Objective To investigate the relationship between risk factors and onset of pulmonary embolism and to develop a proper diagnostic strategy and clinical management for patients with pulmonary thrombosis embolism（PTE）.Methods Predisposing factors,clinical manifestation,treatment and outcomes of 33 consecutive patients with established pulmonary embolism were analyzed retrospectively.The patients were confirmatively diagnosed in our hospital from 2005 to 2011.Results The patients with PTE often had one or more risky factors.The most common clinical manifestation of PTE was unexplained dyspnea with deep venous thrombosis（DVT） in the lower extremity.Other common symptoms and signs included tachypnea,chestpain,syncope and tachycardia.Blood gas analysis,electrocardiography,chest X ray,ultrasonography and D-dimer testing were predictive for the diagnosis of PTE.CT pulmonary angiography（CTPA） were common diagnostic techniques for PTE.The mortality rate was 21.2% for pulmonary embolism（7 deaths）,and 24 of the patients survived after treatment.Deep venous thrombosis（DVT） was a dominant risky factor to PTE.Conclusions The incidence of pulmonary embolism is closely related to the associated factors.CT scan,deep vein Doppler echography play an important role in diagnosis.Thrombolytic treatment can improve the survival rate of patients with pulmonary embolism.