老年人恶性肿瘤合并致死性肺栓塞19例尸检病理及临床分析  

Fatal pulmonary embolism in the elderly with malignant tumor： a clinical pathological analysis of 19 autopsy cases

作　　者：刘保逸[1] 张子瑾[2] 何青[1] 方保民[3] 

机构地区：[1]北京协和医学院研究生院,卫生部北京医院心内科,100730 [2]卫生部北京医院肿瘤内科 [3]卫生部北京医院呼吸科

出　　处：《中华老年医学杂志》2014年第9期955-957,共3页Chinese Journal of Geriatrics

摘　　要：目的 探讨老年恶性肿瘤患者致死性肺动脉栓塞的高危因素、病理特点和临床表现,分析栓子的性质,为临床预防及治疗致死性肺栓塞提供依据. 方法 回顾性分析北京医院1975-2006年尸检证实为致死性肺栓塞的19例病例的病理和临床资料. 结果 恶性肿瘤患者发生致死性肺栓塞占肺栓塞总数的33.9％.病理类型中骑跨型和大块肺栓塞占84.2％,而微小栓塞只占15.8％.其中血栓栓子占84.2％,肿瘤栓子占15.8％,真菌栓子占5.26％.前两位的肿瘤分别为肺腺癌（36.5％）和胰腺癌（15.8％）.临床症状中呼吸困难最多见为78.9％,其次为晕厥为15.8％,体征最多见的是心率增快和发绀. 结论 恶性肿瘤是老年肺栓塞的重要危险因素.老年肿瘤患者致死性肺栓塞的栓子有多种性质,临床应全面考虑导致肺栓塞的原因,从而给予更合理、有效的治疗.Objective To investigate the high risk factors,pathology and clinical features in fatal pulmonary embolism in the elderly patients with malignant tumor,and to analyze the characters of the embolus and provide experimental data for clinical prevention and treatment offatal pulmonary embolism.Methods Autopsy and clinical data of 19 malignancy cases with fatal pulmonary embolism admitted to Beijing Hospital from 1975 to 2006 were retrospectively analyzed.Results 33.9％ of total pulmonary embolism were from malignant diseases （19/56）.Saddle and massive pulmonary embolism were in 84.2％ of total 19 cases,and micro-embolism cases were in only 15.8％.The 84.2％ of embolisms were from pulmonary thromboembolism,15.8％ from tumor emboli,and 5.26％ from fungi emboli.Pulmonary adenocarcinoma was the most common （36.5％）,the second was pancreatic cancer （15.8％）.In all the clinical symptoms,78.9％ of symptoms were dyspnea,15.8％ were syncope.Tachycardia and cyanosis were the common physical signs.Conclusions Malignant tumor is an important risk factor for pulmonary embolism in elderly patients.There are various kinds of emboli in pulmonary embolism in elderly patients with malignant tumor.We should comprehensively consider the causes of pulmonary embolism and give the reasonable and effective treatment to the patients.

关 键 词：肺栓塞 肿瘤 尸检解剖 病理学 临床 

分 类 号：R563.5[医药卫生—呼吸系统]