急性肺栓塞的早期诊断策略分析  

Strategy of Early Diagnosis in Acute Pulmonary Embolism

作　　者：刘捷安[1] 蓝光明[1] 林爱玲[1] 

机构地区：[1]广东省东莞市人民医院急诊科,广东东莞523018

出　　处：《中国现代医生》2009年第32期46-47,共2页China Modern Doctor

摘　　要：目的分析肺栓塞(pulmonary embolism,PE)患者的临床资料,寻找早期诊断的应对策略。方法对29例确诊PE患者临床资料进行回顾性分析,探索早期诊断的有效指标。结果29例患者中存在高危因素占96.55%,其中常见深静脉血栓形成占31.03%。临床表现中呼吸困难占48.28%,晕厥占17.24%。血气分析异常占100%,其中动脉氧分压(PaO2)和肺泡-动脉血氧分压差[P(A-a)O2]显著异常。D-二聚体阳性率为82.75%。心电图异常占91.32%,其中多为V1、V2导联ST-T改变。超声心动图异常占82.75%,表现为右房、右室肥大,肺动脉压力增高。结论患者存在高危因素,突然出现呼吸困难、晕厥,结合D-二聚体阳性或血气分析中PaO2和/或P(A-a)O2异常应考虑肺栓塞;动态观察心电图变化,床边超声心动图检查,可为肺栓塞早期诊断提供线索。Objective To analyze the clinical data of patients with pulmonary embolism and to investigate the corresponding strategies of early diagnosis . Methods The clinical data of 29 patients diagnosed as pulmonary embolism were retrospectively analyzed and the effective indeses of early diagnosis were explored. Results Those with high risk factors accounted for 96.55% in 29 eases,including common deep venom,s thrombosis （31.03%）. According to clinical manifestations of 29 cases,the positive rate of dyspneic respiration was 48.28% and the positive rate of apopsychia was 17.24%. Blood gas analysis of all patients was abnormal,in which the abnormality of partial pressure of oxygen in arterial blood（PaO2） and alveolar-arterial partial pressure of oxygen[P（A-a）O2] was more significant. The positive rate of D-dimeride was 32.75%. The abnormal rate of electrocardiogram（EKE） was 91.32% and special appearance was ST-T in V1 and V2. The abnormal rate of echocardiography was 82.75% ,and special appearance showed right atrium hypertrophy,fight ventricular hypertrophy and the increased pressure of arteria pulmonalis. Conclusion Occurrence of high risk factors,abrupted onset dyspneic respiration or apopsychia,positive D-dimeride and abnormal PaO2 or P（A-a）O2 will be considered to be pulmonary embolism. Dynamic EKG observation and echocardiography monitoring are useful in the early diagnosis of pulmonary embolism.

关 键 词：肺栓塞 早期诊断 

分 类 号：R563.5[医药卫生—呼吸系统]