呼吸困难患者肺栓塞的患病率及危险因素分析  

Analyse of the prevalence rate and risk factors of pulmonary embolism in the patients with dyspnea

作　　者：曹艳霞[1] 代瑞廷[2] 苏剑[1] 王彬生[1] 吴颂红[1] 曹彩霞[3] 

机构地区：[1]河北省职工医学院附属医院核医学科,保定071000 [2]河北省职工医学院附属医院内科,保定071000 [3]保定市中心血站

出　　处：《中华核医学杂志》2005年第5期291-292,共2页Chinese Journal of Nuclear Medicine

摘　　要：目的研究呼吸困难患者肺栓塞发病情况及其危险因素,探讨其发生的诱因及早期临床特征。方法对461例因胸闷气短行肺灌注+通气显像或肺灌注显像+X线胸片检查的住院患者进行回顾性分析,以其中既往体健仅出现胸闷气短患者48例为对照组,余合并不同基础疾病或其他情况并出现胸闷气短患者为病例组;应用PEMS统计软件对患病率(π)进行区间估计、x2检验和肺栓塞的危险度分析。结果461例患者确诊肺栓塞251例,合并基础疾病或其他情况[π的95%置信区间(CI)]有:下肢静脉血栓或曲张(80.79—95.47)、剖宫产后(55.64-87.12)、下肢骨手术或骨折(52.76-87.27)、恶性肿瘤术后(52.19-78.19)、房颤或心力衰竭(53.30-74.88)、肥胖(23.14- 50.20)、腹部(非肿瘤)手术后(20.23-59.43)、糖尿病(19.12-63.95)、慢性支气管炎(1.80- 23.06),对照组(3.47-22.66)。除慢性支气管炎患者外,病例组与对照组肺栓塞π差异有显著性(P<0.05)。结论胸闷气短患者,特别是合并下肢静脉血栓或曲张、心脏病、产后、手术后、下肢骨折、糖尿病、肥胖等情况时,应高度怀疑肺栓塞,尽早行肺灌注/通气显像辅助诊断。Objective To analyse the prevalence rate and risk factors of pulmonary embolism （PE） in patients with dyspnea and to explore the predisposing causes and its early clinical manifestations. Methods Retrospective analysis was clone in 461 patients with dyspnea performed ^99Tc^m-macroaggregated albumin （MAA） lung perfusion imaging and ^99Tc^m-DTPA ventilation imaging or^99Tc^m-MAA perfusion imaging and chest X-ray examination. Among them, 48 cases without apparent disease were considered as con- trol group, whereas the remaining patients with other underlying illnesses as patients group. PEMS statistics software package was used for estimation of prevalence rate, x^2 test and PE risk factor analysis. Results There were 251 PE patients among 461 patients, the prevalence rate [ （π） = 95% confidence interval （CI） ] was： lower extremity thrombosis and varicosity （ 80.79 ± 95.47 ） , post cesarean section （ 55.64 ±87. 12 ） ,lower extremity bone surgery or fracture （ 52.76 ± 87.27 ） , cancer operation （ 52.19 ± 78.19 ） , at- rial fibrillation or heart failure （ 53.30 ± 74.88 ）, obesity （ 23.14 ± 50.20 ）, post abdominal surgery （ 20.23 ± 59.43 ） , diabetes （ 19.12 ± 63.95 ） , chronic bronchitis （ 1.80 ± 23.06 ） , normal control group （ 3.47 ± 22. 66 ）. Except chronic bronchitis, PE prevalence rate between patients group and control group bad significant difference （ P 〈 0.05 ）. Conclusion In patients with dyspnea, especially complicated with lower extremity thrombosis and varicosity, post cesarean section, post surgery, obesity, fracture of lower extremities, diabetes, etc. must be highly suspected with PE and ^99Tc^m-MAA and DTPA lung imaging should be done as early as possible.

关 键 词：呼吸困难 肺栓塞 患病率 危险因素 放射性核素显像 危险因素分析 住院患者 肺灌注显像 下肢静脉血栓 慢性支气管炎 

分 类 号：R563.5[医药卫生—呼吸系统]