摘要
目的观察慢性肺源性心脏病(慢性肺心病)合并急性肺血栓栓塞(APTE)患者的临床特征并进行分析.方法选取25例慢性肺心病合并APTE患者作为观察组,将同期就诊的25例慢性肺心病急性发作患者作为对照组进行配对比较.收集两组患者症状体征、实验室指标、肺动脉收缩压、Wells评分及心电图结果.结果两组患者咳嗽、胸痛、呼吸困难、咯血、发热、晕厥、胸腔积液及完全/不完全右束支传导阻滞的发生率差异无统计学意义(P>0.05).观察组不对称性下肢水肿及下肢深静脉血栓(DVT)发生率、血D-二聚体、血N端脑钠肽前体(NT-proBNP)、肺动脉收缩压、Wells评分、心电图中SⅠQⅢTⅢ及窦性心动过速发生率明显高于对照组,而动脉氧分压(PaO2)及动脉二氧化碳分压(PaCO2)明显低于对照组,差异有统计学意义(P<0.05).多元回归分析显示:不对称性下肢水肿、DVT、血D-二聚体、血NT-proBNP、Wells评分为慢性肺心病合并APTE的独立危险因素.结论慢性肺心病合并APTE患者临床症状缺乏特异性,需进行详细体格检查和相关实验室及物理检查,以明确诊断,对于高风险患者,应尽早行CT肺动脉造影.
Objective To observe and analyze the clinical characteristics of chronic pulmonary heart disease pa-tients complicated with acute pulmonary thromboembolism(APTE).Methods There were 25 chronic pulmonary heart disease patients complicated with APTE were included as observation group and 25 patients with acute episode of chronic corpulmonale included as control group.The patients were compared in pairs.The symptoms and signs,laboratory inde-xes,pulmonary artery systolic pressure,Wells score and electrocardiogram results were collected for compared.Results There was no statstically significant difference in incidences of cough,chest pain,dyspnea,hemoptysis,fever,syncope,pleural effusion or complete/incomplete right bundIe branch block between the two groups(P>0.05).The incidences of asymmetry lower limb swelling and deep venous thrombosis(DVT),D-dimer and N-terminal pro-brain natriuretic peptide(NT-proBNP)levels of blood,pulmonary artery systolic pressure,Wells score and the incidence of SⅠQⅢTⅢand nodal tachycardia of observation group were significant higher than control group;while PaO2 and PaCO2 levels were significant lower than control group(P<0.05).Multiple regression analysis showed that asymmetry lower limb swelling,DVT,D-dimer and NT-proBNP levels of blood and Wells score were independent risk factors for chronic pulmonary heart disease patients complicated with APTE.Conclusion The clinical manifestation of chronic pulmonary heart disease patients complicated with APTE is often atypical.To clarify the diagnosis,detailed medical,Iaboratory and physical exam-ination are required.To high risk patients,computed tomography pulmonary angiography must be performed.
作者
冯颖
董丽霞
FENG Ying;DONG Li-xia(Department of Medicine,Tianjin Prevention and Treatment Center of Occupational Diseases(Workers Hospital),Tianjun 300020,China;不详)
出处
《广东医学》
CAS
2020年第17期1773-1777,共5页
Guangdong Medical Journal
关键词
慢性肺源性心脏病
急性肺血栓栓塞
临床特征
D-二聚体
N端脑钠肽前体
chronic pulmonary heart disease
acute pulmonary thromboembolism
the clinical characteristics
D-dimer
N-terminal pro-brain natriuretic peptide
