CAJ | 학술논문

目的：探讨急性肺血栓栓塞症（PTE ）的临床特点。方法收集经CT肺动脉造影（CTPA）确诊的185例PTE患者的临床资料，总结其发生PTE 的危险因素，临床表现、辅助检查及治疗、预后。同时，按年龄将患者分为两组，高龄组（年龄＞40岁）139例和非高龄组（年龄≤40岁）46例，比较两组患者的临床特征。结果本组急性PTE患者的危险因素主要分布为年龄（＞40岁，75.1％），其次为下肢静脉血栓形成（DVT，45.9％）和急性感染性疾病（33.0％）。PTE最常见的症状是呼吸困难（68.1％），最常见的体征为呼吸频率加快（35.1％），动脉血气分析主要表现为低氧血症合并低碳酸血症（36.6％）及低氧血症（33.8％），血浆D-二聚体＞500μg/L者占70.9％，胸部X线片主要表现为片状浸润影（49.6％），心电图主要表现为窦性心动过速（21.1％），心脏彩色多普勒超声检查主要表现为肺动脉高压（46.8％）。单纯抗凝治疗135例，溶栓治疗35例，放置下腔静脉滤器植入术5例，肺动脉取栓术1例，放弃治疗出院9例。经治疗的176例患者中，病情好转164例（88.7％），恶化6例（3.2％），死亡6例（3.2％）。高龄组患者的高血压病、糖尿病的发病率明显高于非高龄组，非高龄组肾病综合征的发病率明显高于高龄组，P均＜0.01；高龄组咯血的发生率明显低于非高龄组，无明显体征者也高于非高龄组，P均＜0.05。结论急性PTE患者主要临床特征为呼吸困难、低氧血症、高水平D-二聚体、胸部片状影、肺动脉高压，经治疗后多数患者好转，高龄、下肢静脉血栓形成的患者如出现呼吸困难要警惕PTE 的可能，急性感染性疾病是引起急性PTE的高危因素之一。不同年龄患者临床表现可有不同。
목적：탐토급성폐혈전전새증（PTE ）적림상특점。방법수집경CT폐동맥조영（CTPA）학진적185례PTE환자적림상자료，총결기발생PTE 적위험인소，림상표현、보조검사급치료、예후。동시，안년령장환자분위량조，고령조（년령＞40세）139례화비고령조（년령≤40세）46례，비교량조환자적림상특정。결과본조급성PTE환자적위험인소주요분포위년령（＞40세，75.1％），기차위하지정맥혈전형성（DVT，45.9％）화급성감염성질병（33.0％）。PTE최상견적증상시호흡곤난（68.1％），최상견적체정위호흡빈솔가쾌（35.1％），동맥혈기분석주요표현위저양혈증합병저탄산혈증（36.6％）급저양혈증（33.8％），혈장D-이취체＞500μg/L자점70.9％，흉부X선편주요표현위편상침윤영（49.6％），심전도주요표현위두성심동과속（21.1％），심장채색다보륵초성검사주요표현위폐동맥고압（46.8％）。단순항응치료135례，용전치료35례，방치하강정맥려기식입술5례，폐동맥취전술1례，방기치료출원9례。경치료적176례환자중，병정호전164례（88.7％），악화6례（3.2％），사망6례（3.2％）。고령조환자적고혈압병、당뇨병적발병솔명현고우비고령조，비고령조신병종합정적발병솔명현고우고령조，P균＜0.01；고령조각혈적발생솔명현저우비고령조，무명현체정자야고우비고령조，P균＜0.05。결론급성PTE환자주요림상특정위호흡곤난、저양혈증、고수평D-이취체、흉부편상영、폐동맥고압，경치료후다수환자호전，고령、하지정맥혈전형성적환자여출현호흡곤난요경척PTE 적가능，급성감염성질병시인기급성PTE적고위인소지일。불동년령환자림상표현가유불동。
Objective To explore the clinical characteristics of pulmonary thromboembolism(PTE).Method The clinical data of 1 85 PTE patients diagnosed by CT pulmonary angiography were collected,and their clinical characteristics,diagnosis and treatment were analyzed. Meanwhile,the patients were divided into two groups according to age,the older group (age >40 years,n=1 39 )and non-elderly group (age ≤ 40 years,n=46),and their clinical characteristics were compared. Result The most common risk factors were age (>40 years old,75.1%) and deep vein thromboembolism (45.9%) and acute infectious diseases (33.0%). Dyspnea was the main symptom in patients with PTE (68.1%),otherwise shortness of breath was the main sign in patients with PTE (35.1%). The arterial blood gas mostly showed hypocapnia and hypoxemia (36.6%),hypoxemia (33.8%). Patients whose D-dimer was more than 500 μg/L accounted for 70.9%.The main sign of chest X-ray was infiltration (49.6%). Sinus tachycardia (21.1%)was the most common abnormality in electrocardiogram. The main sign of echocardiography was Pulmonary hypertension (46.8%).1 35 cases received anticoagulation,35 cases received thrombolytic therapy,5 cases received implanting inferior vena cave filter tube therapy,one case received pulmonary embolectomy and 9 cases refused treatment. 1 64 ca-ses (88.7%)got improved,6 cases (3.2%)got progress and 6 cases (3.2%)died after treatment. The in-cidence of hypertension and diabetes in elderly group was significantly higher than those in non-elderly group.Meanwhile,the incidence of nephritic syndrome in non-elderly group was significantly higher than that in elder-ly group,P<0.01. Percentage of hemoptysis in the elderly group was significantly lower than that in non-eld-erly group,and percentage of patients without obvious signs were also higher than that in non-elderly group,P<0.05. Conclusion The main clinical characteristics of acute PTE patients were dyspnea,hypoxemia,high D-Dimer and pulmonary infiltrates,pulmonary hypertension. Most PTE patients received treatment can get im-provement. Patients who have risk factors of PTE and have dyspnea may suffer from PTE. Clinical manifesta-tions in patients of different ages may be different.