摘要
目的分析急性肺血栓栓塞症（PTE）的临床特征及诊断过程，以降低漏诊率和误诊率。方法回顾性分析2003年1月至2011年10月沈阳军区总医院住院的316例急性PTE患者的年住院例数、危险因素、临床特征、辅助检查、首诊科室和确诊时间等临床资料。结果急性PTE的住院例数逐年增加。年龄≥60岁为192例（60．76％），冠动脉粥样硬化性心脏病96例（30．38％），高血压病83例（26．27％），近期手术史52例（16．46％），合并下肢深静脉血栓形成史101例（31．96％）。急性PTE临床表现多种多样，其中呼吸困难最常见，有257例（81．34％），胸闷102例（32．28％）、胸痛77例（24．37Vo）、咳嗽68例（21．52％）、晕厥57例（18．04％）、咯血10例（3．16％），其中同时出现呼吸困难、胸痛、咯血“三联征”仅有9例（2．85％）。D-二聚体〉500μg／L者222（85．06％），D二聚体〈500μg／L者39例（14．94％）；心电图检查呈现SIQⅢTⅢ的仅8例（3．62％）；通过肺通气／灌注（V／Q）扫描检查确诊为急性PTE者255例（80．70％）；通过螺旋CT肺血管造影（CTPA）确诊58例（i8．35％）。首诊科室以急诊科和呼吸科为主，分别为134例（42．41％）和130例（41．14％），心血管内科为40例（12．66％），其余12例散在分布在其他8个科室。316例急性PTE患者的平均确诊时间为（44．57±53．52）h，其中呼吸科的平均确诊时间为（31．45±48．05）h，急诊科为（45．52±53．84）h，心血管内科为（64．60±42．84）h。呼吸科的平均确诊时间明显短于心血管内科及急诊科（P值均〈0．05）。结论急性PTE的发病率逐年增高。年龄是其最常见的危险因素，其临床症状复杂多样，缺乏特异性。首诊科室以急诊科、呼吸科及心血管内科为主。因此，提高首诊科室对急性PTE的认识，加强主要科室的培训工作，提高对高危人群的筛查，才能有效的提高急性PTE的诊断水平。
Objective To analyze the clinical characteristics and diagnostic process of acute pulmonary thromboembolism （PTE）, in order to reduce the missed diagnostic and misdiagnostic rate. Methods Clinical data of 316 cases with acute PTE in our hospital from January 2003 to October 2011 were collected, with their general information, risk factors, clinical features, auxiliary examinamtion, the first visited department and diagnostic time analyzed. Results A number of inpatients with acute PTE are growing year by year. Age≥60 years in 192 cases （60.76%）, lower extremity deep vein thrombosis history in 101 cases （31.96%）,96 cases of coronary heart disease （30.38%）,83 cases of hypertension （26.27%）, the recent history of operation in 52 cases （16.46%）. Clinical manifestations of acute PTE are of diversity and without specificity, including dyspnea is most common,257 cases （81.34%）, chest distress 32.28% ,chest pain 24.37%, cough 21.52%, syncope 18.04%, haemoptysis 3.16%, among them experienced combination of dyspnoea, chest pain and haemoptysis only in 9 cases （2.85%）. D-dimer〉 500 μg/L in 222 （85.060% ）, D-dimer% 500 μg/L in 39 cases （ 14.94 % ）. Electrocardiogram showed S I Q % T % in only 8 cases （3.62% ）. Through the lung ventilation/perfusion （V/Q） scan diagnosed as acute PTE in 255 cases （80.70%） and spiral CT pulmonary angiography （CTPA） diagnosed in 58 cases （18.35%）. The first choice of most departments in emergency department, 134 cases （42.41%）, followed by the Department of respiration 130 cases （41.14%） and cardiovascular department of internal medicine 40 cases （12.66%）, the remaining 12 patients were distributed in 8 departments. The average diagnostic time of all 316 cases was （44.57±53.52） h, and in the department of respiratory diseases the average diagnostic time was （31.45±48.05） h, emergency room was （45.52±53.84） h and cardiovascular medicine department was （64.60±42.84） h. The diagnostic time in respiratory department was siginficantly shorter than that in emergency department and in cardiovascular medicine department （ P 〈 0.05）. Conclusions The incidence of acute PTE tends to increase yearly. Clinical manifestations are complicated and non-specific. Its first visited departments are mainly include. So improving the understanding of the first visited department and strengthening the training work of the main departments, can effectively improve diagnostic level of acute PTE.
出处
《国际呼吸杂志》
2013年第19期1467-1470,共4页
International Journal of Respiration
关键词
肺血栓栓塞症
危险因素
诊断
诊断时间
Pulmonary thromboembolism
Risk factors
Diagnosis
Diagnostic time
