肺栓塞的临床研究  

Clinical study on pulmonary embolism

作　　者：刘卓敏[1] 王晋军[2] 刘达怡[2] 

机构地区：[1]山西医科大学第一医院,030001 [2]山西省心血管疾病研究所

出　　处：《山西医药杂志》2001年第6期480-481,共2页Shanxi Medical Journal

摘　　要：目的　探讨肺栓塞的临床特征。方法　经病史采集 ,常规体格检查、胸部 X线片、心电图、超声心动图 ,最后经放射性核素肺灌注 /通气显像确定诊断。结果　 2 8例患者中男 13例 ,女 15例 ,年龄 2 3～ 6 5岁 ,平均(4 4± 12 )岁。病程 1个月～ 3a。栓子来源有下肢深静脉血栓 11例 (占 39.3% ) ,胫腓骨骨折 2例 (占 7.1% )。临床表现有活动性呼吸困难 2 5例 ,心悸 13例 ,胸憋 12例 ,咯血 7例 ,晕厥 4例。体征有心率 >10 0次 / m in者 15例 ,心尖部及三尖瓣区收缩区杂音 10例 ,P2 亢进 2 0例 ,肺呼吸音减弱或部分消失 3例。辅助检查可见 X线显示肺动脉凸出 2 3例 ,右室大 10例 ,可发现肺部密度增高阴影仅 2例。心电图表现 S Q T 仅 6例 ,右室大 10例 ,TV1～ 4倒置 5例 ;超声心动图右室大 2 1例 ,右房大 17例 ,肺动脉高压 14例 ,心包积液 2例。本组病例中有 17例(6 7.9% )曾被误诊。结论　肺栓塞常有活动性呼吸困难 ,心悸 ;X线显示肺动脉凸出 ,超声心动图右室大 ,肺动脉高压应想到本病。放射性核素肺灌注 /通气显像和增强 CT扫描是确诊本病的重要手段。Objective To analyze the clinical feature of patients with pulmonary embolism.Methods Through history collection,physical examination,X ray,ECG and UCG examination the final diagnosis was made by nuclear pulmonary perfusion/ventilation imaging.Results Twenty eight patients with pulmonary embolism were observed.There were 25 patients with symptom of dyspnea,13 patients with palpitation,12 patients with chest oppression,7 patients with hemoptysis and 4 patients with syncope.15 patients with heart rate more than 100 beats per minute.23 patients with pulmonary protrusion in X ray examination.Typical ECG changes S ⅠQ ⅢT Ⅲ were showed only 21.4%.67.9% of patients with pulmonary embolism were misdiagnosed.Conclusion Atypical clinical feature of pulmonary embolism and clinical doctors′ neglect were the main reason for misdiagnosis.When a patients with palpitation,dyspnea and pulmonary protrusion in X ray,pulmonary embolism should be considered.Nuclear pulmonary perfusion/ventilation imaging and reinforced CT scan are the important method for final diagnosis.

关 键 词：肺栓塞 诊断 临床特点 

分 类 号：R563.5[医药卫生—呼吸系统]