肺血栓栓塞症252例临床诊治体会  

Clinical analysis of 252 patients with pulmonary thromboembolism

作　　者：刘晖[1] 马清艳[1] 孙峰[1] 王在义[1] 西艾木西卡买尔·艾合买提[1] 戴月梅[1] 左蕾[1] 林勇[2] 

机构地区：[1]新疆医科大学第一附属医院呼吸二科,乌鲁木齐830054 [2]东南大学附属中大医院呼吸科,江苏南京

出　　处：《中国危重病急救医学》2012年第7期398-401,共4页Chinese Critical Care Medicine

基　　金：国家“十一五”科技支撑计划项目（2006BA101A06）

摘　　要：目的探讨肺血栓栓塞症（PE）患者的临床特点，以提高临床医师对PE的诊治水平。方法回顾性分析252例通过CT肺动脉造影（CTPA）确诊、无严重基础心肺疾病、符合PE诊断标准患者的临床资料，并对其中治疗3个月后复查的32例患者进行随访，比较患者治疗前后心脏超声各项心血管参数和Qanadli栓塞指数（PAQI）的变化。结果在确诊的252例PE患者中，吸烟为重要的危险因素，占44．84％；临床表现以呼吸困难所占比例较大，为84．13％；PE多发生于老年人[64．00（19．75）岁]；当PE患者循环功能受到影响时，血压下降、呼吸急促、脉搏增快；D-二聚体〈5000mg／L时不能排除PE。治疗3个月后复查的32例PE患者PAQI较治疗前明显降低[0．05（0．18）比0．39（0．44），P〈0．01]，而治疗前后心血管参数无明显变化。结论PE临床症状变化多样，老年、吸烟患者出现呼吸困难时警惕PE的可能；经抗凝治疗3个月后，PE造成的心脏形态变化未恢复。Objective To improve the capability of diagnosing and treating for pulmonary thromboembolism （PE） by analyzing the characteristics of PE. Methods Retrospective analysis was performed among 252 patients with PE, diagnosed by CT pulmonary angiography （CTPA） without medical history of serious cardiopulmonary disease. And the before-after comparisons in echocardiography cardiovascular parameters and pulmonary artery Qanadli embolism index （PAQI） were launched within 32 patients who finished 3 months follow-up visiting. Results In 252 patients with final diagnosis of PE, smoking was the most important risk factor, accounted for 44.84%. Dyspnea was the main symptom in patients with PE （84.13%）. PE often occurred in the elderly [ 64.00 （19.75） years old 1. Hypotension, shortness of breath and tachyeardia were always observed when circulatory collapsed. It could not he excluded for PE when D-dimmer was less than 5000 mg/L. In 32 patients rechecked 3 months after treatment, PAQI was significantly decreased compared with that before treatment [0.05 （0.18） vs. 0.39 （0.44）, P〈0.011, but there were no significant differences in cardiovascular parameters before and after treatment. Conclusions The clinical manifestations of PE are variable, it could be considered when the elder or smoker were suffered with dyspnea. After 3 months of anticoagulant therapy, cardiac morphology induced by PE didn＇t get demonstrate improvement.

关 键 词：肺血栓栓塞症 CT肺动脉造影 心脏超声 Qanadli栓塞指数 

分 类 号：R563.5[医药卫生—呼吸系统]