摘要
目的回顾性分析肺栓塞患者的临床症状、体征,危险因素、超声心动图及心电图特征。方法选取2013年1月—2015年7月解放军第474医院行CT肺血管造影(CTPA)并诊断为肺栓塞的患者155例,记录患者的临床特点、危险因素、心电图、超声心动图检查结果。结果 155例肺栓塞患者平均年龄(65.8±16.0)岁,常见临床特征为呼吸困难、咳嗽、胸痛,分别占62.58%、60.65%、34.19%。常见体征为呼吸急促、心率加快、发热、下肢不对称性水肿、发绀,分别占52.26%、29.03%、28.39%、21.29%、18.06%。D-二聚体>500μg/L 131例(84.52%)。血气分析:氧分压<80 mmHg 127例(81.94%),二氧化碳分压<35 mmHg 47例(30.32%),pH>7.45者57例(36.7%)。血常规:白细胞>10×10~9/L44例(28.39%),血小板>300×10~9/L24例(15.48%)。心电图及超声心动图异常包括胸导联T波倒置、S1QIIITIII、右束支传导阻滞、电轴右偏分别占21.05%、12.50%、9.21%和7.89%,右室扩大及肺动脉高压,分别占14.94%和25.32%。常见危险因素为高龄制动、外伤、手术、深静脉血栓栓塞史分别占70.32%、34.84%、15.48%、12.90%和7.10%。就诊于呼吸内科103例(66.45%),心血管内科10例(6.45%),血液、内分泌科4例(2.58%),重症医学科5例(3.23%),急诊科3例(1.94%),外科(普外科、泌尿烧伤外科、骨科、神经外科)30例(19.35%)。接受单纯抗凝治疗患者139例(89.68%),静脉溶栓治疗10例(6.45%),介入取栓2例(1.29%)。院内死亡3例(1.94%)。4例放弃治疗。结论肺栓塞患者缺乏特异性临床特征,需与心肺疾病进行鉴别,结合患者危险因素、心电图及超声心动图等变化,有助于肺栓塞的诊断,并尽早给予抗凝或溶栓治疗,降低患者病死率。
Objective The clinical symptoms,signs,risk factors,echocardiography and ECG features of patients with pulmonary embolism were analyzed retrospectively.Methods From January 2013 to July 2015,in the 474 th Hospital of PLA,155 cases undervvent CT pnlmonary angiography（CTPA） and were diagnosed as pulmonary embolism,record the clinical characteristics,risk factors,patient＇s electrocardiogram,echocardiogram.Resull：155 cases of pulmonary embolism patients with an average age（65.8 ± 16.0） years old,the common clinical features ol dyspnea,cough,chest pain,accounting for 62.58%,respectively,60.65%,34.19%.Common signs and symptoms of shortness of breath,heart rate,fever,lower extremity edema,cyanosis,asymmetry,accounted for 52.26%,29.03%.28.39%,21.29%,18.06%.D- dimer 〉500μg/1.in 131 cases（84.52%）.Blood gas analysis;oxygen partial pressure 〈80 mmHg in 127 cases,carbon dioxide partial pressure 〈35 mmHg in 47 cases（30.32%）,pH 〉7.45 in 57 cases（36.7%）.Blood leukocyte 〉10 × 10^9/L in 44 cases（28.39%）,platelet 〉300 × 10^9/L in 24 cases（15.48%）.The ECG and echocardiographic abnormalities including precordial T wave inversion,S1 QIIITIII,right bundle branch block,right axis deviation accounted for21.05%,12.50%,9.21%and 7.89%,right ventricular enlargement and pulmonary hypertension,respectively accounted for 14.94%and 25.32%.The common risk factors were 70.32%,34.84%,15.48%.and 7.10%,respectively for elderly patients with immobilization,trauma,surgery and deep venous thrombosis.Hospitalized in the respiratory department of 103 eases（66.45%）.10 cases of cardiology department（6.45%.）,4 cases（2.58%） in department of Endocrinology,ICU of 5 eases（3.23%）,3cases of the emergency department（1.94%）,surgery（department of general surgery,department of orthopedics,department of Neurosurgery,department of urinary surgery） in 30 cases（19.35%）.139 patients（n = 10） were treated with inlravenous thrombolytic therapy（89.68%）,and thrombectomy was performed in 2 patients（1.29%）.3 cases（1.94%） died in hospital.4 cases gave up treatment.Conclusion The clinical features of patients with pulmonary embolism,lack of specificity,should be differentiated from patients with pulmonary heart disease,risk factors,electrocardiogram and echocardiography changes contribute to the diagnosis of pulmonary embolism,and given anticoagulant or thrombolytic therapy as soon as possible,reduce the mortality of patients.
作者
黄培
郭世燕
兰秋燕
周慧霞
苏晴
杜凡
HUANG Pei GUO Shiyan LAN Qiuyan ZHOU Huixia SU Qing DU Fan(Department of Radiology, Medical College of Shihezi University, Shihezi 832000, Chin)
出处
《疑难病杂志》
CAS
2017年第2期189-192,共4页
Chinese Journal of Difficult and Complicated Cases
关键词
肺栓塞
临床特点
CT肺血管造影
Pulmonary embolism
Clinical features
CT pulmonary angiography
