静脉血栓栓塞症患者临床特征:10年177例病例分析  

Clinical features of patients with venous thromboembolism: 177 case analysis in 10 years

作　　者：宫蓓蕾[1] 许启霞[1] 庞颖颖[1] 胡俊锋[1] Gong Beilei;Xu Qixia;Pang Yingying;Hu Junfeng(Respiratory and Critical Care Medicine,First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,Anhui,China)

机构地区：[1]蚌埠医学院第一附属医院呼吸与危重症医学科,安徽蚌埠233004

出　　处：《中华危重病急救医学》2019年第4期453-457,共5页Chinese Critical Care Medicine

基　　金：国家重点研发计划项目(2016YFC0905600);"十二五"国家科技支撑计划项目(2011BAI11B17);安徽省高校自然科学研究项目(KJ2015A159).

摘　　要：目的分析确诊静脉血栓栓塞症(VTE)患者的临床特征及危险因素,以提高对VTE的认识,减少漏诊和误诊。方法回顾性分析2009年1月至2018年12月蚌埠医学院第一附属医院收治的经CT肺动脉造影(CTPA)、核素肺通气/灌注(V/Q)显像、下肢静脉超声或静脉造影检查确诊的205例VTE患者的病例资料。分析VTE确诊患者的临床表现、实验室检查结果、影像学结果、治疗与转归;使用肺血栓栓塞症(PTE)简化Wells评分、下肢深静脉血栓形成(DVT)Wells评分进行临床可能性评估;以同期入院的130例非VTE患者作为对照,采用多因素Logistic回归分析筛选VTE发生的危险因素。结果205例VTE患者中,14例病例资料不完整、2例合并其他疾病病情恶化、2例因经济原因、10例因病重放弃治疗而被排除,最终177例患者纳入分析。177例VTE患者的临床症状以胸闷为主(36.16%),其次为胸痛(29.94%)、呼吸困难(29.38%)、咯血(24.29%);以单/双侧下肢肿胀或压痛(38.98%)及肺部湿啰音(20.90%)为常见体征;心电图以ST-T改变为主(49.15%),其次为SⅠQⅢTⅢ或QⅢTⅢ改变(35.03%);血浆D-二聚体<0.5mg/L者仅占5.65%。31.07%(55/177)的患者动脉血气结果正常。177例VTE患者中,经CTPA检查确诊PTE者175例,以双侧/多叶段肺动脉及其分支栓塞为主〔44.57%(78/175)〕;2例经V/Q显像确诊PTE;112例患者接受下肢静脉超声或下肢静脉造影检查,其中确诊为DVT者51例,以腘静脉及以上血栓多见〔68.63%(35/51)〕。临床可能性评估显示,67.23%(119/177)的患者可能发生PTE(PTE简化Wells评分≥2分),38.98%(69/177)的患者可能发生下肢DVT(DVTWells评分≥2分)。多因素Logistic回归分析显示,手术<4周〔优势比(OR)=5.503,95%可信区间(95%CI)=1.577~19.206,P=0.007〕、创伤或骨折<3个月(OR=6.771,95%CI=1.510~30.370,P=0.012)、VTE病史(OR=0.072,95%CI=0.009~0.549,P=0.011)是VTE发生的独立危险因素。177例患者中,接受溶栓治疗13例,单纯抗凝治疗16Objective To analyze the clinical characteristics and risk factors of patients with confirmed venous thromboembolism (VTE) in order to improve recognition of VTE, and reduce the rate of missed diagnosis and wrong diagnosis. Methods A retrospectively review was performed for 205 patients diagnosed with VTE confirmed by CT pulmonary angiography (CTPA), radionuclide pulmonary ventilation/perfusion (V/Q) imaging, lower extremity deep vein ultrasound or venography in the First Affiliated Hospital of Bengbu Medical College from January 2009 to December 2018. The clinical manifestations, laboratory examination results, imaging results, treatment and prognosis of patients diagnosed with VTE were analyzed. The clinical possibility was assessed by pulmonary thromboembolism (PTE) simplified Wells score and deep venous thrombosis (DVT) Wells score. 130 non-VTE patients admitted in the same period were enrolled as controls, and the risk factors of VTE were screened by multivariate Logistic regression analysis. Results Among 205 VTE patients, 14 cases had incomplete data, 2 cases were complicated with other diseases deteriorated, 2 cases were excluded because of economic reasons, 10 cases abandoned treatment because of serious illness, and finally 177 cases were included in the analysis. The main clinical symptoms of VTE patients were chest tightness (36.16%), followed by chest pain (29.94%), dyspnea (29.38%) and hemoptysis (24.29%). Swelling or tenderness of unilateral/bilateral lower extremities (38.98%) and lung moist rale (20.90%) were the most common signs. ST-T changes were the main changes in electrocardiogram (ECG, 49.15%), followed by SⅠQⅢTⅢ or QⅢTⅢ changes (35.03%). Only 5.65% of the patients had plasma D-dimer less than 0.5 mg/L. 31.07%(55/177) patients had normal arterial blood gas results. Of the 177 VTE patients, 175 were diagnosed as PTE by CTPA, with bilateral/multi-lobar pulmonary artery embolism and its branches being the main type [44.57%(78/175)]. Two cases were diagnosed as PTE by V/Q imaging. Am

关 键 词：静脉血栓形成 肺血栓栓塞 临床特点 抗凝 危险因素 

分 类 号：R543.6[医药卫生—心血管疾病]