急性肺栓塞的临床与预后分析  

Clinical and prognostic analysis of the patients with acute pulmonary embolism

作　　者：纵雪梅[1] 王玉芹[2] 陈玉玲[3] 韩寒[1] 许铁[1] 

机构地区：[1]徐州医学院附属医院急救中心,江苏徐州221002 [2]青岛市市立医院重症监护病房,山东青岛266071 [3]徐州医学院附属医院呼吸科

出　　处：《徐州医学院学报》2013年第9期613-617,共5页Acta Academiae Medicinae Xuzhou

摘　　要：目的 通过分析急性肺栓塞（acute pulmonary embolism,APE）患者的临床资料,探讨影响APE患者预后的指标.方法 对徐州医学院附属医院2005年1月-2009年3月诊断为APE的125例住院患者的临床资料进行回顾性分析.结果 危险因素≥2个、PaCO2≤25 mmHg、氧合指数（OI）≤300 mmHg、右心室功能障碍（RVD）、右/左心室舒张末期前后径比（RVED/LVED）≥0.65组患者的住院死亡率、不良事件发生率和随访3个月死亡率明显高于对照组（P＜0.05或P＜0.01）,受试者工作特征曲线（ROC）显示危险因素个数、PaCO2、OI和RVED/LVED判断死亡的最佳分界点分别是1.5、26.0 mmHg、283.86 mmHg 和0.73.未做抗凝或溶栓治疗组患者的住院死亡率显著高于抗凝治疗组或溶栓＋抗凝治疗组（P＜0.01）.肿瘤史、卧床≥5天、晕厥、危险因素个数、心率、PaCO2、OI及RVED/LVED等8个因素与APE患者住院期间的死亡有关.结论 ①危险因素个数、PaCO2、OI、RVD及RVED/LVED是预测APE患者住院死亡率、不良事件发生率或随访3个月死亡率的独立指标.②抗凝治疗或溶栓＋抗凝治疗可以显著降低APE患者的住院死亡率.③肿瘤史、卧床≥5天、晕厥、危险因素个数、心率、PaCO2、OI及RVED/LVED等8个因素与APE患者住院期间的死亡有关.Objective To investigate the indicators of prognosis in patients with acute pulmonary embolism （APE） by analyzing the clinical data of patients with APE. Method The clinical data of 125 patients with APE, who were hos- pitalized in the Affiliated Hospital of Xuzhou Medical College from January 2005 to March 2009 were analyzed retrospec- tively. Results The in - hospital mortality, incidence of adverse events and mortality at 3 months follow - up in group of patients with the number of risk factors ≥2, PaCO2 ≤25 mmHg, oxygenation index （OI） ≤ 300 mmHg, right ventricular dysfunction（RVD）, and right/left ventricular end -diastolic diameter ratio in parasternal long -axis view （RVED/ LVED） ≥0.65 were significantly higher than in control group （P 〈0.05 or P 〈0.01 ）. ROC curve showed that the best cut - off points of the number of risk factors, PaCOz, OI, and RVED/LVED for judging of death were 1.5, 26.0 mmHg, 283.86 mmHg, and 0.73. The mortality in group of patients without anticoagulant or thrombolytic therapy was signifi- cantly higher than group of patients with anticoagulant therapy or thrombolytic plus anticoagulant therapy （ P 〈 0.01 ）. Univariate analysis demonstrated 8 parameters correlated with death in hospital as follows ： tumor, a history of bed rest for 5 days or more, syncope, the number of risk factors, heart rate, PaCO2 , OI, and RVED/LVED. Conclusions ① The number of risk factors, PaCO2 , OI, RVD and RVED/LVED are the independent indicators of mortality, incidence of ad- verse events and mortality at 3 months follow - up in patients with APE. ② Anticoagulant therapy or thrombolytic plus an- ticoagulant therapy can significantly reduce the mortality of the patients with APE. ③ The 8 parameters correlated with death in hospital are as follows： tumor, a history of bed rest for 5 days or more, syncope, the number of risk factors, heart rate, PaCO2, OI, and RVED/LVED.

关 键 词：急性肺栓塞 临床 危险因素 预后 

分 类 号：R563.5[医药卫生—呼吸系统]