产褥期急性肺动脉栓塞的临床表现及诊断  

Clinical manifestations and diagnosis of acute pulmonary embolism during puerperium

作　　者：蒋昊翔[1] 宋旸[2] 李满祥[2] 

机构地区：[1]西安交通大学医学院第一附属医院影像科,陕西西安710061 [2]西安交通大学医学院第一附属医院呼吸与危重症医学科,陕西西安710061

出　　处：《中国妇幼健康研究》2016年第4期482-484,526,共4页Chinese Journal of Woman and Child Health Research

基　　金：国家自然科学基金资助项目(81070045);卫生部部属(管)医院临床学科重点资助项目(111)

摘　　要：目的通过分析产褥期急性肺动脉栓塞(PE)的临床特点,提高对该病的诊疗水平。方法回顾性收集2009年1月至2015年12月在西安交通大学第一附属医院诊断的19例产褥期急性PE及12例非PE患者,分析其临床表现及实验室检查结果。结果与非PE患者相比,急性PE患者主要表现为突发性呼吸困难和呼吸急促,两组间比较差异均有统计学意义(x^2值分别为6.09、13.46,均P<0.05),而胸疼和咳血症状组间比较无明显差异(均P>0.05)。有11例急性PE患者伴有心动过速,8例PE患者伴有下肢深静脉血栓,与非PE组对比差异均有统计学意义((x^2值分别为5.13、6.81,均P<0.05)。另外,在22例血浆D-二聚体水平升高的患者中,有17例为急性PE患者,与非PE组比较差异有统计学意义(x^2=8.16,P<0.05)。结论产褥期急性PE患者临床表现多样化,产妇主要表现为呼吸困难和呼吸急促,如果同时伴有静脉血栓栓塞(VTE)和血浆D-二聚体检查阳性,将有助于对PE更加有效的诊断。Objective To improve the diagnosis and treatment level for pulmonary embolism （PE） during puerperium by analyzing its chnical manifestations. Methods From January 2009 to December 2015, a total of 19 postpartum patients with PE and 12 non-PE patients diagnosed in the First Affiliated Hospital of Xi＇ an Jiaotong University were analyzed retrospectively for clinical manifestations and laboratory results. Results The most common symptoms of cases of acute PE were sudden dyspnea and ecphysesis, and these symptoms showed significant differences between two groups （X2 value was 6.09 and 3.46, respectively, both P 〈 0.05 ）, but there were no significant differences in chest pain and hemoptysis （ both P 〉 0.05）. There were 11 cases of PE with tachycardia and 8 with deep venous thrombosis of lower limbs respectively, which showed significant differences compared with non-PE cases （X2 value was 5.13 and 6.81, respectively, both P 〈 0.05）. Moreover, of 22 cases with increased plasma level of D-dimer, there were 17 cases of acute PE. There was significant difference between two groups （X2 = 8.16,P 〈 0.05）. Conclusion The clinical manifestations of acute PE during puerperium are various. The popular symptoms are ecphysesis and dyspnea. If puerperas have these symptoms accompanied by venous thromboembolism （VTE） and D-dimer testing positive, it is helpful for effective diagnosis of PE.

关 键 词：产褥期 肺动脉栓塞 深静脉血栓 D-二聚体 

分 类 号：R714.7[医药卫生—妇产科学]