中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2011年
5期
309-312
,共4页
杜捷夫%雷永红%杨光%孟庆义%沈洪
杜捷伕%雷永紅%楊光%孟慶義%瀋洪
두첩부%뢰영홍%양광%맹경의%침홍
单中心临床病例分析%肺栓塞%发病
單中心臨床病例分析%肺栓塞%髮病
단중심림상병례분석%폐전새%발병
Single medical center%Pulmonary embolism%Incidence of disease
目的 评价单中心医疗机构20年间肺栓塞(PE)发病情况及其与患者基础疾病的相关性.方法 回顾性分析1989年1月至2009年1月在解放军总医院住院治疗的PE患者临床资料,分析PE患者发病规律及合并的基础疾病,并对PE发病各影响因素进行相关性分析.结果 20年间共救治505例PE患者,其发病率呈逐年增加趋势,2004年后病例陡然增加[61.2%(309)比38.8%(196)];PE发病年龄段以41～60岁为主,各年龄段均有发病;男女比例为1.52:1,男性发病率明显高于女性[60.4%(305)比39.6%(200)].505例PE患者中出现呼吸困难、胸痛、咯血三联征者占40.0%;其中呼吸困难(100.0%)、咯血(52.1%)、胸痛(40.0%)为首要症状.31.1%的PE患者伴有深静脉血栓形成(DVT)史,19.8%伴有静脉曲张,9.5%近期(≤30 d)伴有手术史,22.0%伴有肿瘤,3.6%近期(≤4 d)罹患脑血管疾病,17.4%伴各种感染,10.1%伴有原发性肺动脉高压,16.8%伴有各类心肺疾病史;经多因素Logistic回归分析发现,PE的发生与手术外伤、DVT、肿瘤呈显著相关性[相对比值比(95%可信区间),OR(95%CI)分别为4.540(2.186～9.443)、0.325(0.155～0.682)、2.610(1.020～6.708),P＜0.05或P＜0.01];与服用避孕药、原发性肺动脉高压、脑血管意外发生有一定相关性[OR(95%CI)分别为0.297(0.078～1.126)、3.210(0.855～12.110)、2.939(0.862～10.020),均P＞0.05],与年龄、感染发生的相关性不显著[OR(95%CI)分别为1.041(0.674～1.607)、0.820(0.410～1.665),均P＞0.05].结论 PE不易诊断,但随着对PE认识的提高、诊断意识的增强,PE确诊率逐年增加.对于有手术外伤史、DVT及肿瘤的患者如出现原因不明的呼吸困难、胸痛、咯血等临床表现时,应警惕发生PE的可能并及时进行有关检查,可有效减少PE早期误治并提高PE患者存活率.
目的 評價單中心醫療機構20年間肺栓塞(PE)髮病情況及其與患者基礎疾病的相關性.方法 迴顧性分析1989年1月至2009年1月在解放軍總醫院住院治療的PE患者臨床資料,分析PE患者髮病規律及閤併的基礎疾病,併對PE髮病各影響因素進行相關性分析.結果 20年間共救治505例PE患者,其髮病率呈逐年增加趨勢,2004年後病例陡然增加[61.2%(309)比38.8%(196)];PE髮病年齡段以41～60歲為主,各年齡段均有髮病;男女比例為1.52:1,男性髮病率明顯高于女性[60.4%(305)比39.6%(200)].505例PE患者中齣現呼吸睏難、胸痛、咯血三聯徵者佔40.0%;其中呼吸睏難(100.0%)、咯血(52.1%)、胸痛(40.0%)為首要癥狀.31.1%的PE患者伴有深靜脈血栓形成(DVT)史,19.8%伴有靜脈麯張,9.5%近期(≤30 d)伴有手術史,22.0%伴有腫瘤,3.6%近期(≤4 d)罹患腦血管疾病,17.4%伴各種感染,10.1%伴有原髮性肺動脈高壓,16.8%伴有各類心肺疾病史;經多因素Logistic迴歸分析髮現,PE的髮生與手術外傷、DVT、腫瘤呈顯著相關性[相對比值比(95%可信區間),OR(95%CI)分彆為4.540(2.186～9.443)、0.325(0.155～0.682)、2.610(1.020～6.708),P＜0.05或P＜0.01];與服用避孕藥、原髮性肺動脈高壓、腦血管意外髮生有一定相關性[OR(95%CI)分彆為0.297(0.078～1.126)、3.210(0.855～12.110)、2.939(0.862～10.020),均P＞0.05],與年齡、感染髮生的相關性不顯著[OR(95%CI)分彆為1.041(0.674～1.607)、0.820(0.410～1.665),均P＞0.05].結論 PE不易診斷,但隨著對PE認識的提高、診斷意識的增彊,PE確診率逐年增加.對于有手術外傷史、DVT及腫瘤的患者如齣現原因不明的呼吸睏難、胸痛、咯血等臨床錶現時,應警惕髮生PE的可能併及時進行有關檢查,可有效減少PE早期誤治併提高PE患者存活率.
목적 평개단중심의료궤구20년간폐전새(PE)발병정황급기여환자기출질병적상관성.방법 회고성분석1989년1월지2009년1월재해방군총의원주원치료적PE환자림상자료,분석PE환자발병규률급합병적기출질병,병대PE발병각영향인소진행상관성분석.결과 20년간공구치505례PE환자,기발병솔정축년증가추세,2004년후병례두연증가[61.2%(309)비38.8%(196)];PE발병년령단이41～60세위주,각년령단균유발병;남녀비례위1.52:1,남성발병솔명현고우녀성[60.4%(305)비39.6%(200)].505례PE환자중출현호흡곤난、흉통、각혈삼련정자점40.0%;기중호흡곤난(100.0%)、각혈(52.1%)、흉통(40.0%)위수요증상.31.1%적PE환자반유심정맥혈전형성(DVT)사,19.8%반유정맥곡장,9.5%근기(≤30 d)반유수술사,22.0%반유종류,3.6%근기(≤4 d)리환뇌혈관질병,17.4%반각충감염,10.1%반유원발성폐동맥고압,16.8%반유각류심폐질병사;경다인소Logistic회귀분석발현,PE적발생여수술외상、DVT、종류정현저상관성[상대비치비(95%가신구간),OR(95%CI)분별위4.540(2.186～9.443)、0.325(0.155～0.682)、2.610(1.020～6.708),P＜0.05혹P＜0.01];여복용피잉약、원발성폐동맥고압、뇌혈관의외발생유일정상관성[OR(95%CI)분별위0.297(0.078～1.126)、3.210(0.855～12.110)、2.939(0.862～10.020),균P＞0.05],여년령、감염발생적상관성불현저[OR(95%CI)분별위1.041(0.674～1.607)、0.820(0.410～1.665),균P＞0.05].결론 PE불역진단,단수착대PE인식적제고、진단의식적증강,PE학진솔축년증가.대우유수술외상사、DVT급종류적환자여출현원인불명적호흡곤난、흉통、각혈등림상표현시,응경척발생PE적가능병급시진행유관검사,가유효감소PE조기오치병제고PE환자존활솔.
Objective To evaluate the correlation of pulmonary embolism (PE) and original diseases by retrospectively analysis of the patients for 20 years in single medical center. Methods Five hundred and five patients with PE were admitted and treated in General Hospital of Chinese PLA from January 1989 to January 2009, and their clinical data were retrospectively reviewed to analyze the risk factors of PE and the correlations of PE with the original diseases. Results Of the 505 patients with PE in the past 20 years, the incidence of PE was increased year by year, especially it increased spectacularly after the year of 2004 [61.2% (309) vs. 38.8% (196)]. It was found to be most prevalent in patients of 41 - 60 years old. Its incidence in males was 1.52 folds higher than that of the females [60. 4% (305) vs. 39.6% (200)].Dyspnea, chest pain and hemoptysis were the initial symptoms in the PE patients. Among the 505 patients,40.0% of them complained dyspnea with chest pain and hemoptysis. Among them, dyspnea occurred in 100.0% of patients, hemoptysis in 52.1%, and chest pain in 40.0%. In 31.1% of the patients if was complicated with deep venous thrombosis (DVT), 19. 8% of them suffering from varicosity, 9. 5% of them had the history of surgery less than 30 days before, 22. 0% of them suffering from neoplasm, 3. 6% of them were accompanied with cerebrovascular disease within 4 days, 17.4% of them were accompanied with infection, 10. 1 % of them were accompanied with primary pulmonary hypertension, and 16. 8% of them were accompanied with heart diseases. Multivariate analysis showed that the history of surgery, DVT and neoplasm had significant correlation with the occurrence of PE [odds ratio (95% confidence interval), OR (95%CI) was 4.540 (2.186-9.443), 0.325 (0.155 -0.682), 2.610 (1.020-6.708), P＜0.05 or P＜ 0. 013, while oral contraception, primary pulmonary hypertension and cerebrovascular disease showed a less significant correlation with the occurrence of PE [OR (95%CI) was 0. 297 (0. 078 - 1. 126), 3. 210 (0. 855 -12. 110), 2. 939 (0. 862 - 10. 020), all P＞0. 05]. The age and infection did not show significant correlation with the occurrence of PE [OR (95%CI) was 1. 041 (0. 674 - 1. 607) and 0. 820 (0. 410 - 1. 665), both P＞0.05]. Conclusion The PE is difficult in diagnosis, but with increasing cognizance, the diagnostic rate of PE has been increased. Patients with history of surgical operation, DVT or neoplasm, who complain dyspnea without known cause, chest pain or hemoptysis, should be subjected to further examinations, as to confirm the diagnosis of PE, then the survival rate of the patients with PE may be elevated.
