CAJ | 학술논문

目的探讨老年人肺栓塞的临床特点及溶栓、抗凝治疗的疗效.方法回顾性分析72例60岁以上肺血栓栓塞患者的临床表现、诊断方法及溶栓、抗凝治疗和转归.结果本组72例老年急性肺栓塞患者均患2种和(或)2种以上慢性疾病,其中高血压41例(56.9%),下肢深静脉血栓30例(53.6%),冠心病26例(36.1%),肿瘤9例(12.5%),手术和骨折15例(20.8%).72例患者中出现呼吸困难66例(91.7%),咳嗽22例(30.6%),胸痛20例(27.8%),紫绀13例(18.1%),晕厥10例(13.9%),咯血9例(12.5%),下肢水肿32例(44.4%),肺部湿哕音23例(31.9%),P2亢进13例(18.1%),血管杂音4例(5.6%).血氧分析61例中53例(86.9%)有不同程度的低氧血症,其中37例(60.7%)伴低碳酸血症.31例患者检测肺泡动脉氧压差,其中有27例增高(87.1%).56例血管超声检查,发现有不同程度的下肢深静脉血栓者30例(53.6%).61例患者常规取血行D-二聚体检查,50例呈阳性,阳性率82.0%.62例患者行螺旋CT肺动脉造影(CTPA)检查,其中58例有肺段以上肺动脉不同部位血栓,阳性率为93.5%.CT影像中肺动脉纤细及肺纹理稀疏6例,梗死灶8例,片状影10例,马赛克征及肺动脉增粗2例.16例患者行核素肺通气/灌注(V/Q)显像检查,均显示高度可能肺栓塞,阳性率为100%.进一步行CTPA检查,该16例均发现肺段以上肺动脉血栓形成,阳性率100%.72例均行溶栓抗凝治疗,治愈1 6例(22.2%),显效22例(30.6%),有效25例(34.7%),无效或恶化9例(12.5%),其中5例(6.9%)死亡.溶栓和抗凝治疗效果明显优于单纯抗凝治疗(有效率:86.2%对30.2%,P＜0.01),治疗中未出现出血现象.结论老年肺栓塞最常见危险因素为高血压和下肢深静脉血栓形成,其临床表现以呼吸困难为首发,症状复杂多样且不典型,CTPA对老年肺栓塞诊断具有可靠性和准确性,溶栓抗凝治疗安全、有效.
목적 탐토노년인폐전새적림상특점급용전、항응치료적료효.방법 회고성분석72례60세이상폐혈전전새환자적림상표현、진단방법급용전、항응치료화전귀.결과 본조72례노년급성폐전새환자균환2충화(혹)2충이상만성질병,기중고혈압41례(56.9%),하지심정맥혈전30례(53.6%),관심병26례(36.1%),종류9례(12.5%),수술화골절15례(20.8%).72례환자중출현호흡곤난66례(91.7%),해수22례(30.6%),흉통20례(27.8%),자감13례(18.1%),훈궐10례(13.9%),각혈9례(12.5%),하지수종32례(44.4%),폐부습홰음23례(31.9%),P2항진13례(18.1%),혈관잡음4례(5.6%).혈양분석61례중53례(86.9%)유불동정도적저양혈증,기중37례(60.7%)반저탄산혈증.31례환자검측폐포동맥양압차,기중유27례증고(87.1%).56례혈관초성검사,발현유불동정도적하지심정맥혈전자30례(53.6%).61례환자상규취혈행D-이취체검사,50례정양성,양성솔82.0%.62례환자행라선CT폐동맥조영(CTPA)검사,기중58례유폐단이상폐동맥불동부위혈전,양성솔위93.5%.CT영상중폐동맥섬세급폐문리희소6례,경사조8례,편상영10례,마새극정급폐동맥증조2례.16례환자행핵소폐통기/관주(V/Q)현상검사,균현시고도가능폐전새,양성솔위100%.진일보행CTPA검사,해16례균발현폐단이상폐동맥혈전형성,양성솔100%.72례균행용전항응치료,치유1 6례(22.2%),현효22례(30.6%),유효25례(34.7%),무효혹악화9례(12.5%),기중5례(6.9%)사망.용전화항응치료효과명현우우단순항응치료(유효솔:86.2%대30.2%,P＜0.01),치료중미출현출혈현상.결론 노년폐전새최상견위험인소위고혈압화하지심정맥혈전형성,기림상표현이호흡곤난위수발,증상복잡다양차불전형,CTPA대노년폐전새진단구유가고성화준학성,용전항응치료안전、유효.
Objective To explore the elinical characteristics and the effects of thrombolytic and anti-coagulation therapy on pulmonary embolism(PE)in over 60-year-old patients. Methods The clinical findings,diagnostic techniques,effects of thrombolytic and anti coagulation therapy in 72 patients with PE aged over 60-year were analyzed retrospectively. Results Each one of 72 patients in this study suffered from two or more chronic diseases.Hypertension(56.9%)and deep venous thrombosis(DVT)in lower limbs(53.6%)were the most common thrombosis risk factors in the study.The clinical findings were atypical in elderly patients with PE.Different degree of dyspnea was the main characteristics(91.7%).Other findings were cough(30.6%),chest pain(27.8%),cyanosis (18.1%),faint(13.9%)and emptysis(12.5%).The objective signs showed edema of lower extremity (44.4%),moist rales(31.9%),P2 accentuation(18.1%),vascular murmur(5.6%).Blood gas analysis in 61 cases showed that 53 patients suffered from hypoxemia(86.9%)along with 37 cases of hypocapnia(60.7%).The alveolar-arterial oxygen gradient was increased in 27/31 cases(87.1%)and blood D-dipolymer was positive in 50/61 cases(82.0%).Spiral CT pulmonary angiogram(CTPA)in 62 cases and radioactive nuclear ventilation perfusion scan in 16 cases demonstrated PE in 58(93.5%) and 16(100%)patients respectively.The cure rate of thrombolytic therapy combined with anti-coagulation versus anti-coagulation therapy alone was 86.2%versus 30.2%(P=0.000).There was no haemorrhagia phenomenon during thrombolytic and anti-coagulation therapy. Conclusions The most common risk factors of PE in the elderly are hypertension and DVT in Iower limbs.The clinical symptoms are atypical and variable.Dyspnea is the main characteristics.Thrombolytic with anti-coagulation therapy is safe and effective,but anti-coagulation therapy alone has no benefit.