摘要
目的 :探讨肺栓塞的临床特点、诊断程序、治疗措施和预后的影响因素。方法 :对我院1995～ 2 0 0 3年确诊的 38例肺栓塞病例的资料进行回顾性分析。结果 :肺栓塞患者以 4 0～ 6 0岁年龄段所占比例最高。肺栓塞易患因素居前 2位的分别为心血管疾病和静脉血管病。肺栓塞的常见症状有呼吸困难、咳嗽、心悸、胸痛、咯血、晕厥等。实验室检查 ,D -二聚体阳性者占 77.8% ,肺核素扫描显示肺段灌注缺损的敏感性为 10 0 %。接受溶栓治疗的患者 ,死亡率为 2 3.1% ,接受抗凝治疗的患者 ,死亡率为 38.5 %。发现收缩压 <90mmHg、PaO2 <6 5mmHg、PaCO2 <2 5mmHg、P(A-a)O2 较高及受累肺段数较多等是肺栓塞预后不良的影响因素。结论 :肺栓塞的临床表现多样 ,对于有心血管疾病的中老年患者 ,当出现呼吸系统症状时要警惕肺栓塞的可能 ,应根据病情的轻重缓急制定相关的检查和治疗方案。对于存在预后不良影响因素的肺栓塞患者 ,要高度警惕 ,加强监测 ,积极治疗 ,争取降低死亡率。
Objective:To investigate the manifestations,proper diagnostic strategy, clinical management and prognosis-influencing factors of pulmonary embolism. Methods: Data of 38 patients with pulmonary embolism who were hospitalized in our hospital from 1995 to 2003 were analyzed retrospectively. Results: Most patients with pulmonary embolism were at the age of 40～60. Cardiovascular disease was the first predisposing factor and veno-vascular disease was the second. The main manifestations included dyspnea, cough, palpitation, chest pain, hemoptysis and syncope. Abnormal high levels of D-dimer were demonstrated in 77.8% of patients. All the patients who experienced pulmonary perfusion scintigraphy had at least one segmental perfusion defect. The mortality of patients who subjected to thrombolytic therapy and anticoagulant therapy were 23.1% and 38.5% respectively. Systolic pressure <90 mmHg,PaO 2<65 mmHg,PaCO 2<25 mmHg,increasing P(A-a)O 2 and the involvement of more pulmonary segment were adverse prognosis-influencing factors. Conclusions: The manifestations of pulmonary embolism were variform. The possibility of pulmonary embolism should be considered in old patients with cardiovascular disease when feel uncomfortable in respiratory system. Proper diagnostic strategy and clinical management should be established depending on the severity of the disease and pay much attention and treat energetically to the pulmonary embolism patients who have the adverse prognosis-influencing factors.
出处
《内科急危重症杂志》
2004年第4期192-194,202,共4页
Journal of Critical Care In Internal Medicine
关键词
肺栓塞
诊断
预后
Pulmonary embolism Diagnosis Prognosis
