肺血栓栓塞症患者83例回顾性分析  

83 patients with pulmonary thromboembolism were retrospectively analyzed

作　　者：李开来[1] 杨珺楠[1] 陈名珍[1] 温宏[1] 

机构地区：[1]北京大学首钢医院干部保健科,北京100144

出　　处：《中国临床医生杂志》2014年第5期28-30,共3页Chinese Journal For Clinicians

摘　　要：目的探讨肺血栓栓塞症患者的诊断方法及危险因素。方法选择本院确诊为肺血栓栓塞症的患者83例,回顾性分析所有患者的危险因素、临床表现和辅助检查结果。结果呼吸困难为肺血栓栓塞症最早出现也是最常见的症状。肺血栓栓塞症时可有PaO2和PaCO2下降、pH升高、肺泡-动脉血氧分压差增大,血液中D-二聚体浓度升高(>500ng/ml),心电图SⅠQⅢTⅢ表现,超声心动图可见肺动脉压增高、右心扩大和三尖瓣反流增快。V/Q扫描及CTPA检查可确诊肺血栓栓塞症。肺血栓栓塞症的高危因素主要年龄、高血压、冠心病、下肢深静脉血栓形成、脑梗死及手术外伤。结论由于大多数肺血栓栓塞症患者的临床表现不典型,临床上对于存在肺血栓栓塞症高危因素的患者应提高警惕,及早联合应用V/Q扫描及CTPA检查予以确诊以减少误诊率及漏诊率。Objective Analysis the diagnosis method and risk factors of Pulmonary thrombo-embolism （ PTE ） Pa-tients. Method The risk factors, clinical presentation and results of auxiliary examinations in 83 PTE patients were retrospectively analyzed. Result Dyspnea was the earliest and most frequent symptom in PTE patients. PTE could have PaO2 and PaCO2 decreased, pH value increased, the difference of Alveolar arterial oxygen partial pressure in-creased. The concentration of D-dimer in blood increased. And with a SIQⅢTⅢperformance in electrocardiogram. The echocardiogram may have performance of pulmonary hypertension, right heart enlargement and atrioventricular valve reflux quicker. Ventilation-perfusion scintigraphy （ V/Q scan） and Helico-Computerized Tomography Pul-monary Arteriography（CTPA） could identify PTE. The main risk factors for PTE were age, hypertension（HBP）, coronary heart disease（ CHD） ,deep venous thrombosis（ DVT） , cerbral infarction, operation and/or trauma. Con-clusion Because most PTE patients have no typical clinical presentation, we should raise our vigilance when we make our diagnosis on patients who have risk factors of PTE. The combined application of V/Q scan and CTPA ear-lier could reduce the misdiagnosis rate and missed diagnosis.

关 键 词：肺血栓栓塞症 临床表现 诊断 危险因素 呼吸困难 V/Q扫描 

分 类 号：R563.5[医药卫生—呼吸系统]