老年肺栓塞患者的临床特点分析  

Diagnosis and clinical analysis of pulmonary embolism in aging patients

作　　者：杨珺楠[1] 陈名珍[1] 温宏[1] 李开来[1] 王宏宇[2] 

机构地区：[1]北京大学首钢医院干部保健科,100144 [2]北京大学首钢医院干部血管医学科,100144

出　　处：《北京医学》2012年第5期352-355,共4页Beijing Medical Journal

摘　　要：目的探讨老年肺栓塞的临床特点和诊断方法,减少误诊率和漏诊率。方法回顾性分析我院确诊的60例老年(≥65岁)肺栓塞的高危因素、临床表现和辅助检查结果。结果老年肺栓塞的危险因素为下肢静脉血栓(DVT,33.3%)、手术外伤(25.0%)、长期卧床(23.3%)。呼吸困难为最常见症状(80.0%),96.7%患者临床症状缺乏特异性。螺旋CT肺动脉造影(CTPA)结果显示老年患者肺栓塞部位主要为右下叶肺动脉(38.9%)、右肺动脉(35.2%)和左下叶肺动脉(29.6%),53.7%的患者为多支血管受累。核素肺通气/灌注扫描(V/Q扫描)的阳性率为73.9%,CTPA的阳性率为65.2%,43.5%的患者V/Q扫描和CTPA均为阳性,二者联用的检出率为95.7%。结论老年肺栓塞表现为多处、主要血管受累,以右肺动脉和双下叶肺动脉多见。提高老年肺栓塞的诊断水平,及时正确的诊断和治疗可改善预后,降低病死率。推荐联合使用V/Q扫描和CTPA检查。Objective To analyze the clinical characteristics and diagnostic method of pulmonary embolism in aging patients. Methods The risk factors, clinical presentations and results of ancillary examinations of 60 older patients（≥ 65 years old） were retrospectively analyzed. Results The main risk factom for Aged-PE were deep venous thrombosis （DVT,33.3%）, operation and/or trauma （25.0%）, and prolonged bed rest （23.3%）. Dyspnea was the most frequent symptom （80.0%）, but the majority （97%） had no specific symptoms.Helico-Computerized Tomography Pulmonary Arteriography（CTPA） showed that the main positions of Aged-PE were right inferior pulmonary artery（38.9%）, right pulmonary artery（35.2%） and left inferior pulmonary artery （29.6%）, 53.7% patients had several vessels involved. The positive rate of Ventila- tion-perfusion scintigraphy （V/Q scan） was 73.9%. The positive rate of CTPA was 65.2%. 43.5% patients had a V/Q scan and CTPA positivity. The detection rate of combined use of the two examinations was 95.7%. Conclusion Multi-vessels and one major vessel can be involved in most Aged-PE. The right pulmonary artery, right and left inferior pulmonary artery are the most frequently involved. It is necessary to improve the diagnosis of pulmonary embolism inaged-patients. Timely diagnosis and treatment can improve the outcome and reduce the mortality rate. The combined use of V/Q scan and CTPA is recommended.

关 键 词：肺栓塞 老年 诊断 临床特点 

分 类 号：R563.5[医药卫生—呼吸系统]