COVID-19合并肺血栓栓塞症的临床特点  

Clinical characteristics of COVID-19 complicated with pulmonary thromboembolism

作　　者：谷松涛[1] 贾玮[1] 李月川[1] 张冬睿[1] 张雅婷[1] 高淑连[1] 李娜 GU Songtao;JIA Wei;LI Yuechuan;ZHANG Dongrui;ZHANG Yating;GAO Shuian;LI Na(Department of Respiratory and Critical Care Medicine,Tianjin Chest Hospital,Tianjin 300222,China)

机构地区：[1]天津市胸科医院呼吸与危重症医学科,300222

出　　处：《天津医药》2023年第8期873-878,共6页Tianjin Medical Journal

摘　　要：目的探讨新型冠状病毒肺炎(COVID-19)合并肺血栓栓塞症的临床特点。方法收集2022年12月—2023年1月27例COVID-19合并肺血栓栓塞症患者资料,根据临床信息、实验室检查、心电图、超声心动图、影像学检查和诊治方案等资料,总结患者的临床及预后特征。结果27例患者中男12例,女15例,年龄64~93岁,平均(71.78±9.21)岁。既往有冠心病9例,恶性肿瘤7例,慢性阻塞性肺疾病4例,陈旧性肺结核2例,肺间质纤维化1例;临床主要表现为活动后气促、咳嗽、发热及胸腔积液,多数患者心电图表现为胸导联T波倒置(12/27);超声表现为下肢深静脉血栓形成(13/27);CT影像学主要表现为双肺多发磨玻璃影(21/27)、实变影(17/27)、段肺动脉栓塞(23/27)、亚段及以下肺动脉栓塞(10/27)。11例伴右心功能不全,入院30d内死亡2例,均为高龄患者。结论当恶性肿瘤和慢性心肺疾病患者出现不能解释的呼吸困难等表现时应考虑COVID-19合并肺血栓栓塞症的可能,影像学多表现为双肺磨玻璃影伴段及以下肺动脉栓塞,其中合并右心室功能不全的高龄患者预后不佳。Objective To study the clinical features of novel coronavirus pneumonia(COVID-19)complicated with pulmonary thromboembolism.Methods A total of 27 patients with COVID-19 complicated with pulmonary thromboembolism were collected from December 2022 to January 2023 in the department of respiratory and critical care medicine,Tianjin Chest Hospital.The clinical features and prognosis of patients were summarized based on clinical information,laboratory tests,electrocardiogram,echocardiography,CT images,diagnosis and treatment.Results Among the 27 patients,12 were males and 15 were females.The mean age was(71.78±9.21)years,ranged in age from 64 to 93 years old.There were 7 cases of coronary heart disease,7 cases of malignant tumor,4 cases of chronic obstructive pulmonary disease,2 cases of pulmonary tuberculosis and 1 case of pulmonary interstitial fibrosis.The main clinical manifestations were shortness of breath,cough,fever and pleural effusion.The electrocardiogram of most patients showed that T-wave of chest lead was inverted(12/27).Ultrasonography revealed deep venous thrombosis of lower extremity(13/27).The main CT findings were multiple ground-glass opacity(21/27),consolidation(17/27),segmental pulmonary embolism(23/27)and subsegmental pulmonary embolism(10/27).There were 11 patients accompanied by right ventricular dysfunction(RVD)and 2 died within 30 days after admission.All of them were elderly patients.Conclusion When patients with malignant tumors and chronic cardiopulmonary diseases have unexplained dyspnea and other manifestations,the possibility of COVID-19 combined with pulmonary thromboembolism should be considered.The imaging findings are mostly segmental and subsegmental pulmonary embolism with ground-glass opacity of both lungs.The prognosis of elderly patients with right ventricular dysfunction is not good.

关 键 词：新型冠状病毒肺炎 新型冠状病毒 肺栓塞 预后 

分 类 号：R563.12[医药卫生—呼吸系统]