中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2013年
1期
37-40
,共4页
范晓红%王春%范阜东%杨媛华
範曉紅%王春%範阜東%楊媛華
범효홍%왕춘%범부동%양원화
肺栓塞%危险因素%因素分析,统计学
肺栓塞%危險因素%因素分析,統計學
폐전새%위험인소%인소분석,통계학
Pulmonary embolism%Risk factors%Factor analysis,statistical
目的 探讨老年人急性肺栓塞患者临床表现和危险因素的差异. 方法 将141例经CT肺动脉造影(CTPA)或直接肺动脉造影或放射性核素肺灌注显像结合临床资料确诊的急性肺栓塞患者按年龄分为老年组78例和非老年组63例,比较两组临床表现和危险因素的差异,并选取同时段在我院进行常规体检的100例为对照组,采用多元Logistic回归模型分析老年人急性肺栓塞危险因素. 结果 老年组和非老年组呼吸困难、咳嗽、胸闷、胸痛的患病率分别为88.5％ (69例)与84.1％(53例)、76.9％(60例)与69.8％(44例)、56.4％(44例)与63.5％(40例)、15.4％(12例)与25.4％(16例),两组比较差异无统计学意义(均为P＞0.05),但老年组咯血的患病率9.0％(7例),低于非老年组23.8％(15例)(P＜0.05),老年组无症状患者9.0％(7例)比非老年组1.6％(1例)多,但差异无统计学意义(P＞0.05)；老年组的危险因素多见于糖尿病(x2 =7.41,P＜0.01)、高血压(x2=14.51,P＜0.01)、慢性阻塞性肺疾病(COPD)(x2=7.42,P＜0.01)和既往脑卒中(x2=4.91,P＜0.05),老年组的独立危险因素分别为COPD(OR:3.29,95％CI:1.04～10.46)、既往深静脉血栓史(OR:4.72,95％CI:1.68～13.27)、恶性肿瘤(OR:4.35,95％CI:1.00～18.13,)和既往脑卒中(OR:5.13,95％CI:1.15～24.52)；非老年组为既往深静脉血栓史(OR:11.94,95％CI:3.35～42.60)和恶性肿瘤(OR∶11.44,95％CI:1.44～89.92). 结论 老年急性肺栓塞患者的临床表现与非老年组相似,多不典型,虽然呼吸困难仍为最常见的临床表现,但不明原因的咳嗽和胸闷应警惕；COPD、恶性肿瘤、既往深静脉血栓和脑卒中史均为老年人急性肺栓塞的独立危险因素,需注意加以鉴别.
目的 探討老年人急性肺栓塞患者臨床錶現和危險因素的差異. 方法 將141例經CT肺動脈造影(CTPA)或直接肺動脈造影或放射性覈素肺灌註顯像結閤臨床資料確診的急性肺栓塞患者按年齡分為老年組78例和非老年組63例,比較兩組臨床錶現和危險因素的差異,併選取同時段在我院進行常規體檢的100例為對照組,採用多元Logistic迴歸模型分析老年人急性肺栓塞危險因素. 結果 老年組和非老年組呼吸睏難、咳嗽、胸悶、胸痛的患病率分彆為88.5％ (69例)與84.1％(53例)、76.9％(60例)與69.8％(44例)、56.4％(44例)與63.5％(40例)、15.4％(12例)與25.4％(16例),兩組比較差異無統計學意義(均為P＞0.05),但老年組咯血的患病率9.0％(7例),低于非老年組23.8％(15例)(P＜0.05),老年組無癥狀患者9.0％(7例)比非老年組1.6％(1例)多,但差異無統計學意義(P＞0.05)；老年組的危險因素多見于糖尿病(x2 =7.41,P＜0.01)、高血壓(x2=14.51,P＜0.01)、慢性阻塞性肺疾病(COPD)(x2=7.42,P＜0.01)和既往腦卒中(x2=4.91,P＜0.05),老年組的獨立危險因素分彆為COPD(OR:3.29,95％CI:1.04～10.46)、既往深靜脈血栓史(OR:4.72,95％CI:1.68～13.27)、噁性腫瘤(OR:4.35,95％CI:1.00～18.13,)和既往腦卒中(OR:5.13,95％CI:1.15～24.52)；非老年組為既往深靜脈血栓史(OR:11.94,95％CI:3.35～42.60)和噁性腫瘤(OR∶11.44,95％CI:1.44～89.92). 結論 老年急性肺栓塞患者的臨床錶現與非老年組相似,多不典型,雖然呼吸睏難仍為最常見的臨床錶現,但不明原因的咳嗽和胸悶應警惕；COPD、噁性腫瘤、既往深靜脈血栓和腦卒中史均為老年人急性肺栓塞的獨立危險因素,需註意加以鑒彆.
목적 탐토노년인급성폐전새환자림상표현화위험인소적차이. 방법 장141례경CT폐동맥조영(CTPA)혹직접폐동맥조영혹방사성핵소폐관주현상결합림상자료학진적급성폐전새환자안년령분위노년조78례화비노년조63례,비교량조림상표현화위험인소적차이,병선취동시단재아원진행상규체검적100례위대조조,채용다원Logistic회귀모형분석노년인급성폐전새위험인소. 결과 노년조화비노년조호흡곤난、해수、흉민、흉통적환병솔분별위88.5％ (69례)여84.1％(53례)、76.9％(60례)여69.8％(44례)、56.4％(44례)여63.5％(40례)、15.4％(12례)여25.4％(16례),량조비교차이무통계학의의(균위P＞0.05),단노년조각혈적환병솔9.0％(7례),저우비노년조23.8％(15례)(P＜0.05),노년조무증상환자9.0％(7례)비비노년조1.6％(1례)다,단차이무통계학의의(P＞0.05)；노년조적위험인소다견우당뇨병(x2 =7.41,P＜0.01)、고혈압(x2=14.51,P＜0.01)、만성조새성폐질병(COPD)(x2=7.42,P＜0.01)화기왕뇌졸중(x2=4.91,P＜0.05),노년조적독립위험인소분별위COPD(OR:3.29,95％CI:1.04～10.46)、기왕심정맥혈전사(OR:4.72,95％CI:1.68～13.27)、악성종류(OR:4.35,95％CI:1.00～18.13,)화기왕뇌졸중(OR:5.13,95％CI:1.15～24.52)；비노년조위기왕심정맥혈전사(OR:11.94,95％CI:3.35～42.60)화악성종류(OR∶11.44,95％CI:1.44～89.92). 결론 노년급성폐전새환자적림상표현여비노년조상사,다불전형,수연호흡곤난잉위최상견적림상표현,단불명원인적해수화흉민응경척；COPD、악성종류、기왕심정맥혈전화뇌졸중사균위노년인급성폐전새적독립위험인소,수주의가이감별.
Objective To investigate the differences in clinical symptoms and risk factors between non-elderly and elderly patients with acute pulmonary thromboembolism(PTE).Methods Totally141 patients with acute PTE and 100 sex and age-matched healthy controls were enrolled in the study.The final diagnosis was confirmed by CT pulmonary angiography (CTPA) and/or pulmonary angiography and/or pulmonary perfusion imaging as well as medical history.The patients with acute PTE were divided into two groups according age:elderly group (n=78,age≥60 years),young group (n =63,age ＜ 60 years).Multivariate Logistic regression analysis was performed to identify independent risk factors of PTE and to confirm the risk of each factor.Results The morbidity rate of dyspnea,cough,chest distress and chest pain were 88.5％ (69 cases),76.9％ (60 cases),56.4％ (44 cases),15.4％ (12 cases) in elderly group,which was similar to 84.1％ (53 cases),69.8％ (44 cases),63.5％ (40 cases),25.4％ (16 cases) in young group (all P＞0.05)； while the morbidity rate of hemoptysis in elderly group [9.0％ (7 cases)] was lower than in young group [23.8％(15 cases)](P＜0.05).9％ (7 cases) in elderly patients without any symptoms were more than 1.6％ (1 cases) in young patients,but no significant differene (P＞0.05).There were more risk factors in the elderly group accompanying with diabetes (x2 =7.41,P ＜ 0.01),hypertension (x2 =14.51,P＜ 0.01),chronic obstructive pulmonary diseases (COPD) (x2 =7.42,P＜0.01) and previous stroke (x2 =4.91,P＜0.05)compared with young group.Independent risk factors for elderly acute PTE included COPD (OR:3.29,95％CI:1.04-10.46),previous deep veneus thrombosis(DVT) (OR:4.72,95％CI:1.68-13.27),cancers (OR:4.35,95％CI:1.00-18.13) and previous stroke (OR:5.13,95％CI:1.15-24.52).Independent risk factors for non-elderly PTE included previous DVT (OR:11.94,95％ CI:3.35-42.60)and cancers (OR:11.44,95％CI:1.44-89.92).Conclusions Much attention should be paid to the identification of diagnosis of acute PTE depending on the non-specific clinical features,although dyspnea may be the most frequency symptoms,but unexplained cough and chest distress should be alert for PTE.COPD,cancer,DVT and previous stroke are independent and important risk factors for elderly acute PTE.
