47例肺血栓栓塞症患者尸检资料分析

目的 了解肺血栓栓塞症(PTE)患者尸检的临床及病理特点,提高对PTE的认识.方法 回顾性分析重庆医科大学2004-2015年经尸检证实为PTE的47例死亡患者的临床及病理资料.结果 12年间共完成尸检784例,其中PTE 47例(2例合并脂肪栓塞),发生率6.0％.47例PTE病例中有46例(97.9％)为致死性肺栓塞(FPE).分析47例PTE病例尸检资料发现,每例均至少存在一项危险因素,43例(91.5％)存在2项及以上危险因素,其中最常见危险因素为创伤骨折(55.3％)及手术(53.2％).临床症状以呼吸困难(40.4％)、心搏骤停(31.9％)及晕厥(27.7％)常见;24例(51.1％)合并下肢深静脉血栓形成(DVT),8例(17.0％)合并右心血栓,1例(2.1％)合并基底动脉血栓.栓塞部位以肺动脉主干(59.6％)多见,其中骑跨型栓塞20例(42.6％).22例(46.8％)死亡前疑诊为PTE,但均未行抗凝或溶栓治疗,仅1例予低分子肝素预防性抗凝治疗.结论 PTE容易继发于有高危因素的患者,尤其是创伤骨折及手术.其临床症状无特异性,缺乏典型三联征,误诊率、漏诊率及致死率均高,临床工作者对疑诊PTE患者治疗不充足.

Analysis on autopsy data in 47 cases of pulmonary thromboembolism

Objective To investigate the autopsy clinicopathological characteristics of pulmonary thromboembolism(PTE)and to improve the understanding of PTE.Methods The clinicopathological data of 47 death cases of PTE verified by autopsy in the Chongqing Medical University during 2004? 2015 were retrospectively analyzed.Results A total of 784 cases of autopsy were completed during these 12 years,of which 47 cases(6.0％) were proved as PTE (2 cases complicating fat embolism) and 46 cases (97.9％) were fatal pulmonary embolism (FPE).The analysis on 47 cases of autopsy data found that each case had at least 1 risk factor and 43 cases (91.3％) had two or more risk factors,and the most common risk factors were traumatic fracture(55.3％) and surgery (53.2 ％).The frequent clinical symptoms were dyspnea (40.4 ％),cardiac arrest (31.9 ％) and syncope(27.7 ％);24 cases (51.1％) were complicated with deep venous thrombus (DVT) of lower limbs,8 cases (17.0％) of complicating right cardiac thrombus and 1ease (2.1％) of basilar artery embolism were found.The embolism location was dominated by main pulmonary artery (59.6 ％),including 20 cases (42.6 ％) of straddling type pulmonary embolism.Twenty-two cases (46.8 ％) were suspiciously diagnosed as PTE before death,but none was given anticoagulation or thrombolytic therapy.Only 1 case had low molecular heparin to prevent thrombosis.Conclusion PTE is more likely to occur in those patients with high risk factors,especially traumatic fractures and surgeries.Its clinical symptoms have no specificity,lack triad syndrome,has higher misdiagnosis rate,missed diagnosis rate and fatality rate.The treatment on suspected PTE patients by clinicians is insufficient.