CAJ | 학술논문

目的分析急性肺血栓栓塞症(PTE)的发病特点及临床特征,提高临床医师对急性PTE的认识,规范PTE的诊断和治疗.方法 2009年1月1日至2009年12月31日所有入住北京朝阳医院确诊的急性PTE患者,分析其流行病学、危险因素、临床症状、辅助检查、治疗以及临床转归情况.结果 1年内共确诊PTE 137例.住院患者PTE的发病率为0.37％,高于亚洲住院患者PTE的发病率.PTE在冬季多发,住院患者的发病率达0.52％.平均发病年龄(62.14±15.16)岁,60岁以上患者为62.77％.女性(60.58％)多于男性(39.41％).初诊科室分布广泛,以呼吸与危重症医学科为主要科室,为75.18％.危险因素以恶性肿瘤最高,其次为既往有静脉血栓病史.临床表现以呼吸困难为主,其次为胸闷和胸痛.血气分析表现为低氧和(或)低二氧化碳血症.心脏超声提示右心功能障碍者44例,血栓直接征象者5例.下肢静脉超声提示有67.20％的PTE患者合并下肢静脉血栓,以远端静脉多见(67.63％).溶栓抗凝治疗14例,单纯抗凝治疗122例.好转出院134例(97.08％),死亡2例(1.46％).结论提高各临床科室医师对于急性PTE的诊断意识及治疗规范化程度,可以提高确诊率,降低病死率.急性PTE以恶性肿瘤以及静脉血栓栓塞症病史为主要危险因素.临床症状多样,以新发的呼吸困难最为常见.超声心动图及下肢静脉超声检查联合应用可作为疑诊PTE而无确诊手段时的替代诊断方法.
목적 분석급성폐혈전전새증(PTE)적발병특점급림상특정,제고림상의사대급성PTE적인식,규범PTE적진단화치료.방법 2009년1월1일지2009년12월31일소유입주북경조양의원학진적급성PTE환자,분석기류행병학、위험인소、림상증상、보조검사、치료이급림상전귀정황.결과 1년내공학진PTE 137례.주원환자PTE적발병솔위0.37％,고우아주주원환자PTE적발병솔.PTE재동계다발,주원환자적발병솔체0.52％.평균발병년령(62.14±15.16)세,60세이상환자위62.77％.녀성(60.58％)다우남성(39.41％).초진과실분포엄범,이호흡여위중증의학과위주요과실,위75.18％.위험인소이악성종류최고,기차위기왕유정맥혈전병사.림상표현이호흡곤난위주,기차위흉민화흉통.혈기분석표현위저양화(혹)저이양화탄혈증.심장초성제시우심공능장애자44례,혈전직접정상자5례.하지정맥초성제시유67.20％적PTE환자합병하지정맥혈전,이원단정맥다견(67.63％).용전항응치료14례,단순항응치료122례.호전출원134례(97.08％),사망2례(1.46％).결론 제고각림상과실의사대우급성PTE적진단의식급치료규범화정도,가이제고학진솔,강저병사솔.급성PTE이악성종류이급정맥혈전전새증병사위주요위험인소.림상증상다양,이신발적호흡곤난최위상견.초성심동도급하지정맥초성검사연합응용가작위의진PTE이무학진수단시적체대진단방법.
Objective To analyze the clinical characteristics and risk factors of patients with acute pulmonary embolism (PTE),to improve the awareness of PTE for the physicians and to standardize diagnosis and treatment of PTE.Methods The inpatients who were confirmed PTE in Chaoyang Hospital from January 2009 to December 2009 were enrolled in the study.Data on epidemiology,risk factors,clinical symptoms,investigation,treatment and outcome were collected and analyzed.Results A total of 137 patients was confirmed PTE.Patients with PTE account for all inpatients with ratio of 0.37％,which was higher than that in other Aisa areas.People attacked this disease in winter than in other seasons.The morbidity was 0.52％ in winter.The mean age of patients was (62.14±15.16) years,including 54 male patients (39.41％) and 83 female patients (60.58％).Malignant tumor was the first risk factor (29.87％),followed by history of venous thromboembolism (VTE) (28.57％).The main clinical symptoms were dyspnea (68.61％),followed by chest distress (29.19％)and chest pain (17.51％).Blood gas analysis indicated the hypoxia and/or low carbon dioxide.Echocardiography revealed right ventricular dysfunction in 44 cases and thrombus in the right heart cavities or main pulmonary artery in 5 cases.Venous ultrasonography indicated DVT in 84 cases of PTE (67.20 ％),32.37％ in proximal lower extremities and 67.63％ in distal lower extremities.14 patients received both thrombolysis and anticoagulation therapies,122 patients received anticoagulation therapy alone.134 (97.81％) patients were improved and discharged and two patients (1.46％) died.Conclusions Improving the awareness of PTE for the physicians and standardizing diagnosis and treatment of PTE can increase the proven rate and markedly decrease the mortality.The two main risk factors of PTE are cancer and VTE.The symptoms of PTE are diversity and dyspnea is the most frequent symptom.Combination of transthoracic echocardiography and lower extremity vessels ultrasonogaphy can be used as screening method when suspected PTE but no CTPA or V/Q scan available.