老年Wells低评分急性肺栓塞病人的临床特点分析  

Clinical characteristics of elderly patients with acute pulmonary thromboembolism presenting with low Wells score

作　　者：柳毅 殷少军[1] 孔志斌[1] 朱珍[1] 李虹[1] 宋爽[1] 宋一祎 LIU Yi;YIN Shao-jun;KONG Zhi-bin;ZHU Zhen;LI Hong;SONG Shuang;SONG Yi-yi(Department of Respiratory Medicine, Shanghai Sixth People’ s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 201306, China)

机构地区：[1]上海交通大学附属第六人民医院呼吸内科,上海市201306

出　　处：《实用老年医学》2021年第9期923-926,共4页Practical Geriatrics

基　　金：上海市浦东新区科技与民生发展专项基金资助项目(PKJ2019-Y01)。

摘　　要：目的归纳总结老年Wells低评分急性肺栓塞(acute pulmonary embolism,APE)病人的临床特点。方法对我院2009年1月至2015年8月收治的75例老年Wells低评分疑似APE病人的风险因素、临床特征及辅助检查结果进行回顾性分析,将其中21例最终确诊为APE的病人作为病例组,另外54例排除APE的病人作为对照组。采用Logistic回归分析老年Wells低评分病人发生APE的影响因素。结果与对照组相比,病例组合并COPD、CHD病人的比例更高,临床症状以急性呼吸困难、慢性呼吸困难、胸闷、胸痛为主(P<0.05或<0.01)。病例组病人的PaO2、PaCO2、国际标准化比值(INR)水平均显著低于对照组,差异具有统计学意义(P<0.01)。Logistic回归分析显示,COPD(95%CI1.421~261.620)、PaO2(95%CI0.883~0.984)、PaCO2(95%CI0.782~0.972)是老年Wells低评分病人发生APE的独立影响因素。结论当老年病人出现低PaO2血症、低PaCO2血症等表现,或既往有COPD等基础疾病,即使Wells低评分,仍需警惕APE可能。Objective To investigate the clinical characteristics of the elderly patients with acute pulmonary thromboembolism(APE)who showed low Wells score.Methods A retrospective analysis was performed on the risk factors,clinical characteristics and auxiliary examination results of 75 elderly patients with low Wells score who were suspected of APE in our hospital from January 2009 to August 2015.Among them,21 patients finally diagnosed with APE were selected as the case group and the other 54 were selected as the control group.The influencing factors of APE in the elderly patients with low Wells score were analyzed by Logistic regression analysis.Results Compared with the control group,the proportions of the patients with chronic obstructive pulmonary disease(COPD)and coronary heart disease(CHD)in the case group were higher,and the clinical symptoms were mainly acute dyspnea,chronic dyspnea,chest tightness and chest pain(P<0.05 or<0.01).The levels of arterial oxygen partial pressure(PaO2),arterial carbon dioxide partial pressure(PaCO2)and International Normalized Ratio(INR)in the case group were statistically significant lower than those in the control group(P<0.01).Logistic regression analysis revealed that the independent influencing factors of APE in the elderly patients with low Wells score were COPD(95%CI 1.421-261.620),PaO2(95%CI 0.883-0.984)and PaCO2(95%CI 0.782-0.972).Conclusions Clinical workers should pay attention to the elderly patients with low levels of PaCO2 and PaO2,or combined with COPD,even if they Wells score was low,it still need to be alert to the possibility of APE.

关 键 词：WELLS评分 急性肺栓塞 老年人 临床特点 鉴别诊断 

分 类 号：R563.5[医药卫生—呼吸系统]