摘要
目的提高老年肺栓塞临床诊断的准确率,为减少误诊误治提供依据。方法对天津市第三医院2000年1月—2006年12月确诊的资料完整的16例老年肺栓塞病例进行回顾性分析并文献复习。结果16例患者除行基本检查外,全部行胸部螺旋CT及超声心动图检查,无一例行肺动脉造影及肺核素扫描,其中6例被误诊,误诊率达37.5%,2例进展为慢性肺栓塞。老年肺栓塞的高危因素依次为:心血管疾病、制动或卧床、恶性肿瘤、手术、慢性肺部疾病等。治疗原则以溶栓、抗凝为主,2例行下腔静脉置网术。16例中3例治愈,4例显效,4例好转,5例死亡。结论肺栓塞是呼吸科的急危重症,当医院不能即刻提供肺动脉造影或肺核素扫描或重症患者不允许行以上检查,掌握老年肺栓塞的易患因素,密切观察临床症状和体征,通过简单的临床手段(包括血气分析、D-二聚体、心电图、X线胸片和胸部CT、心脏及血管超声检查等)也能临床诊断肺栓塞,及时的溶栓和抗凝治疗可治愈本病或缓解临床症状。
[ Objective] To improve the accuracy of the clinical diagnose of elderly pulmonary embolism （ PE）, and provide evidence for reducing misdiagnosis and mistreatment. [ Methods] 16 cases of confirmed elderly PE with complete data during January 2000 to December 2006 were conducted retrospective analysis and literature review. [ Results] Apart from basic inspection, all 16 patients were examined by spiral CT and chest echocardiography, none of them were conducted pulmonary angiography and lung radionuclide scans, Of which 6 cases were misdiagnosed, misdiagnosis rate were 37.5%, two cases developed chronic PE. Risk factors for elderly PE were： cardiovascular disease, limitation of movement or bedridden, malignant Tumor, surgery, chronic lung disease and so on. Thrombolysis and anticoagnlation were chief treatments, 2 cases received implantation of inferior vena cava filter. 3 patients were cured, 4 patients got apparent efficacy, 4 patients improved, and 5 patients died. [ Conclusion] PE is severe acute disease in respiratory department, if the hospital cannot provide the pulmonary artery angiograms and lung radionuclide scans immediately, or the patients cannot endure such examinations, we should pay attention to the risk factors of elderly PE and watch out for clinical symptoms and physical signs, through the simple clinical examination （including blood gases, D-dimer, ECG, X-ray and chest CT, heart and vascular ultrasonic examination） to diagnose PE. Timely thrombolytic and anticoagulation treatments can cure PE or ease clinical symptoms of PE.
出处
《职业与健康》
CAS
2008年第14期1468-1469,共2页
Occupation and Health
关键词
老年肺栓塞
危险因素
Elderly pulmonary embolism
Risk factors
