急性肺血栓栓塞症伴发晕厥的临床研究

目的:研究急性肺血栓栓塞症(PTE)伴发晕厥时的临床及影像学特点,并评价其治疗转归。方法:516例急性PTE患者,按照是否伴发晕厥分为2组,记录治疗前及治疗后14d的症状、体征,并进行心脏超声、核素肺灌注显像和(或)CT肺动脉造影检查,在治疗后14d进行临床疗效评价。结果:516例急性PTE患者中有67例出现晕厥,发生率13.0%。PTE伴晕厥者以大面积和次大面积PTE为主,心悸的发生率高于无晕厥者(P<0.001),低血压或休克、P2亢进和发绀的发生率明显高于无晕厥者(P<0.01);右心室功能不良在PTE伴晕厥者中多于无晕厥者(69.6%vs40.4%,P<0.001),核素肺灌注显像7个以上肺段受累者(73.3%)多于无晕厥者(48.1%);CT肺动脉造影(CTPA)显示,PTE伴晕厥者有94.7%累及中央肺动脉,而无晕厥者有74.3%累及中央肺动脉(P=0.001);治疗后14d,PTE伴晕厥者死亡4例(6.1%),明显高于无晕厥者(P=0.002)。结论:PTE伴晕厥者多有血流动力学异常或右心功能障碍,肺血管堵塞面积较大,容易发生病情恶化。

The clinical study of acute pulmonary thromboembolism with syncope

Objective:To evaluate the clinical and imaging characteristics and outcome of acute pulmonary thromboembolism (PTE) with syncope.Method:516 acute PTE patients were divided in two groups: 67 patients with syncope and 449 patients without syncope. The symptoms and signs were recorded and ultrasoundcardiogram and lung perfusion scan and/or CT angiography were performed before and after 14d treatment.Result:Patients with syncope had significant reductions in blood pressure and showed a more pronounced tendency to present with right ventricular dysfunction than patients without syncope ( P <0.01 and P <0.001,respectively). Cynosis and S_2P increased were prominent in patients with syncope, and there were more main pulmonary artery embolus in patients with syncope than without syncope ( P =0.001). The mortality was higher in patient with syncope than without syncope ( P =0.002).Conclusion:Hemodynamic unstable and right ventricular dysfunction are seen frequently in patients with syncope, and major area of embolism are commonly, the course may be deteriorated in patient with syncope.