急诊肺栓塞的早期诊治(附26例病例分析)

目的:提高急诊医生对肺栓塞早期诊断的重视程度,掌握正确的诊断程序及治疗措施。方法:对2003～2005年间中日友好医院急诊临床诊断的26例肺栓塞患者的易患因素、临床表现、实验室检查及治疗、预后等进行临床分析。结果:血气分析有低氧血症者占100%,D-二聚体(D-dimer)>500ng/dl者占76.93%,超声心动图呈典型改变者占61.54%,X胸片呈典型肺不张楔型改变占36.77%,放射性核素扫描提示至少一个肺段灌注缺损并与通气不匹配者占76.93%。结论:肺栓塞早期缺乏临床特异性表现,易漏诊、误诊。对于血液动力指标不稳定的急性肺栓塞,结合床旁快速无创检查可确立高度疑似诊断,采用急诊快速溶栓治疗,可提高此类患者的生存率。

Early diagnosis and treatment of pulmonary embolism in emergency

Objective:To improve the clinical diagnostic rate of pulmonary embolism(PE) for physicians in general hospital.Methods:From 2003 to 2005,26 cases of PE hospitalized patients were retrospectively analyzed for underlying diseases,clinical manifestations,laboratory examinations,treatment and prognosis.Results:All the patients had hypoxemia in arterial blood gas analysis.D-dimer detected exceed 500ng/dl accounted for 76.93%.Some patients(61.54%) had typical change in ultrasonic cardiography examination.Chest X-ray change of wedge type accounted for 36.77%.The proportion of radionuclide scanning hinted at least one segment perfusion defect and mismatch venting was 76.93%.Conclusion:The clinical symptoms of PE are not clear.Pulmonary embolism may be mis-diagnosed as other diseases.When the PE patients have instable hemodynamics,we should use fast modern facilitations to identify the suspected diagnosis,and give thrombolysis treatment on time to increase the survival rate.