中国医药
中國醫藥
중국의약
CHINA MEDICINE
2011年
11期
1334-1336
,共3页
马旃%怀志耕%赵兴山%孙华毅
馬旃%懷誌耕%趙興山%孫華毅
마전%부지경%조흥산%손화의
肺栓塞%病因%临床特征
肺栓塞%病因%臨床特徵
폐전새%병인%림상특정
Pulmonary embolism%Etiology%Clinical significance
目的 分析因急性肺动脉血栓栓塞死亡患者的临床特点,探讨高危患者的早期评估方法.方法 1997年6月至2010年12月在我院因急性肺栓寒死亡的住院患者31例,回顾性分析此类患者的临床特点.结果 31例患者肺栓塞从发病到死亡时间为2 h～11 d,其中合并慢性阻塞性肺疾病9例(29.1％)、高血压病16例(51.6％)、冠心病11例(35.5％)、2型糖尿病8例(25.8％)、脑梗死5例(16.1％)、肺部感染16例(51.6％).7例(22.6％)表现为呼吸心跳骤停,其余患者最常见的症状为呼吸困难(24例,77.4％),24例(77.4％)在起病初始出现血压下降.28例(90.3％)D二聚体＞500μ,19例(61.3％) LDH升高,10例(32.3％)cTNI升高,6例(19.4％) AST升高.15例(48.4％)患者心电图出现典型QⅢTⅢSⅠ改变,仅出现QⅢ或SⅠ者15例(48.4％),发生呼吸心跳骤停的7例患者中,5例最初心电图表现为室性逸搏.5例存活超过3天的患者超声心动图可见右心室功能障碍表现.结论 急性肺栓塞死亡患者中,呼吸困难、低血压、心电图呈特征性QⅢTⅢSⅠ改变是最为常见的临床特征,预后不佳,合理利用床边简便检查方法对于尽早识别高危患者、评估预后非常重要.
目的 分析因急性肺動脈血栓栓塞死亡患者的臨床特點,探討高危患者的早期評估方法.方法 1997年6月至2010年12月在我院因急性肺栓寒死亡的住院患者31例,迴顧性分析此類患者的臨床特點.結果 31例患者肺栓塞從髮病到死亡時間為2 h～11 d,其中閤併慢性阻塞性肺疾病9例(29.1％)、高血壓病16例(51.6％)、冠心病11例(35.5％)、2型糖尿病8例(25.8％)、腦梗死5例(16.1％)、肺部感染16例(51.6％).7例(22.6％)錶現為呼吸心跳驟停,其餘患者最常見的癥狀為呼吸睏難(24例,77.4％),24例(77.4％)在起病初始齣現血壓下降.28例(90.3％)D二聚體＞500μ,19例(61.3％) LDH升高,10例(32.3％)cTNI升高,6例(19.4％) AST升高.15例(48.4％)患者心電圖齣現典型QⅢTⅢSⅠ改變,僅齣現QⅢ或SⅠ者15例(48.4％),髮生呼吸心跳驟停的7例患者中,5例最初心電圖錶現為室性逸搏.5例存活超過3天的患者超聲心動圖可見右心室功能障礙錶現.結論 急性肺栓塞死亡患者中,呼吸睏難、低血壓、心電圖呈特徵性QⅢTⅢSⅠ改變是最為常見的臨床特徵,預後不佳,閤理利用床邊簡便檢查方法對于儘早識彆高危患者、評估預後非常重要.
목적 분석인급성폐동맥혈전전새사망환자적림상특점,탐토고위환자적조기평고방법.방법 1997년6월지2010년12월재아원인급성폐전한사망적주원환자31례,회고성분석차류환자적림상특점.결과 31례환자폐전새종발병도사망시간위2 h～11 d,기중합병만성조새성폐질병9례(29.1％)、고혈압병16례(51.6％)、관심병11례(35.5％)、2형당뇨병8례(25.8％)、뇌경사5례(16.1％)、폐부감염16례(51.6％).7례(22.6％)표현위호흡심도취정,기여환자최상견적증상위호흡곤난(24례,77.4％),24례(77.4％)재기병초시출현혈압하강.28례(90.3％)D이취체＞500μ,19례(61.3％) LDH승고,10례(32.3％)cTNI승고,6례(19.4％) AST승고.15례(48.4％)환자심전도출현전형QⅢTⅢSⅠ개변,부출현QⅢ혹SⅠ자15례(48.4％),발생호흡심도취정적7례환자중,5례최초심전도표현위실성일박.5례존활초과3천적환자초성심동도가견우심실공능장애표현.결론 급성폐전새사망환자중,호흡곤난、저혈압、심전도정특정성QⅢTⅢSⅠ개변시최위상견적림상특정,예후불가,합리이용상변간편검사방법대우진조식별고위환자、평고예후비상중요.
Objective To analyze the clinical features of the patients who death due to acute pulmonary embolism and discuss the early assessment method of high risk patients with pulmonary embolism.Methods From June 1997 to December 2010,31 cases suffered acute pulmonary embolism and eventual death.The clinical features of these patients were retrospectively analyzed.Results The time from onset to death of 31 patients were 2 hours to lldays.In these patients,29.1％ associated with COPD,51.6％ with hypertension,35.5％ with coronary heart disease,25.8％ with type 2 diabetes,16.1％ with cerebral infarction,and 51.6％ with lung infection.7 patients suffered respiratory and cardiac arrest.The most common symptoms were shortness of breath (24 cases,77.4％ ).The blood pressure of 77.4％ patients dropped in the initial onset.In D-dimer test,90.3％ patients' is over ＞500 μg/ml.In the indicators of serum enzymes,LDH of the 61.3％ patients increased,cTNI of 32.3％ patients increased,and AST of the 19.4％ patients increased.The ECG of 48.4％ patients appeared QⅢTⅢSⅠ features,also 48.4％ patients showed only QⅢ or SI features.In the patients with respiratory and cardiac arrest,the initial ECG in 5 cases appeared ventricular escape beat.In 5 cases of patients surviving more than 3 days,the UCG showed the performance of right ventricular dysfunction.Conclusion In the patients death due to acute pulmonary embolism,the mostcommon characters were shortness of breath,low blood pressure and QⅢTⅢSⅠ/QⅢ/SⅠ in ECG.The prognosis of them was poor.Rational use of simple bedside examination methods was very important to early identification of high-risk patients and assessing prognosis.
