中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
32期
2534-2540
,共7页
肺栓塞%血栓栓塞%死亡%危险因素
肺栓塞%血栓栓塞%死亡%危險因素
폐전새%혈전전새%사망%위험인소
Pulmonary embolism%Thromboembolism%Death%Risk factors
目的 系统评价肺血栓栓塞症(PTE)患者全因死亡相关危险因素.方法 系统检索PubMed数据库、西文生物医学数据库、中国期刊全文数据库、中国生物医学数据库1995年1月至2011年5月公开发表的关于PTE全因死亡相关危险因素的研究文献,并查阅各个研究中引用的参考文献来补充.观察性研究(队列研究和病例对照研究)参考关于观察性研究方法学质量评估的建议进行评价;随机对照研究利用Jadad量表进行评价.应用Cochrane协作网提供的RevMan 5.1软件,进行一致性检验,使用固定效应模型及随机效应模型进行合并,计算相对危险度(RR),结果以RR值(95％ Cl)表示.结果 最终纳入35篇文献,共计19 613例PTE患者,全因死亡率为0.5％～30.0％,平均(10.7±7.6)％,患者全因死亡率的相关危险因素分别为:右心功能不全[2.18(1.64 ～2.89),P =0.000],D-二聚体阳性[5.19(1.93 ～13.96),P=0.001],血清肌钙蛋白升高[4.01(2.77 ～5.81),P=0.000],低血压[2.76(1.25～6.09),P=0.010],恶性肿瘤[2.65(2.01～ 3.50),P=0.000],充血性心力衰竭[1.90(1.62 ～2.22),P=0.000],慢性肺脏疾病[1.40(1.18 ～1.66),P=0.000],心动过速[1.65(1.23 ～2.20),P=0.000],长期卧床[1.74(1.36～ 2.21),P=0.000],年龄＞65岁[1.24(1.13～ 1.37),P=0.000],并且当多因素共存时死亡风险明显增加.结论 PTE患者全因死亡相关危险因素包括D-二聚体持续阳性、血清肌钙蛋白水平升高、低血压、恶性肿瘤、右心功能不全、长期卧床、充血性心力衰竭、心动过速、慢性肺脏疾病、年龄＞ 65岁等.
目的 繫統評價肺血栓栓塞癥(PTE)患者全因死亡相關危險因素.方法 繫統檢索PubMed數據庫、西文生物醫學數據庫、中國期刊全文數據庫、中國生物醫學數據庫1995年1月至2011年5月公開髮錶的關于PTE全因死亡相關危險因素的研究文獻,併查閱各箇研究中引用的參攷文獻來補充.觀察性研究(隊列研究和病例對照研究)參攷關于觀察性研究方法學質量評估的建議進行評價;隨機對照研究利用Jadad量錶進行評價.應用Cochrane協作網提供的RevMan 5.1軟件,進行一緻性檢驗,使用固定效應模型及隨機效應模型進行閤併,計算相對危險度(RR),結果以RR值(95％ Cl)錶示.結果 最終納入35篇文獻,共計19 613例PTE患者,全因死亡率為0.5％～30.0％,平均(10.7±7.6)％,患者全因死亡率的相關危險因素分彆為:右心功能不全[2.18(1.64 ～2.89),P =0.000],D-二聚體暘性[5.19(1.93 ～13.96),P=0.001],血清肌鈣蛋白升高[4.01(2.77 ～5.81),P=0.000],低血壓[2.76(1.25～6.09),P=0.010],噁性腫瘤[2.65(2.01～ 3.50),P=0.000],充血性心力衰竭[1.90(1.62 ～2.22),P=0.000],慢性肺髒疾病[1.40(1.18 ～1.66),P=0.000],心動過速[1.65(1.23 ～2.20),P=0.000],長期臥床[1.74(1.36～ 2.21),P=0.000],年齡＞65歲[1.24(1.13～ 1.37),P=0.000],併且噹多因素共存時死亡風險明顯增加.結論 PTE患者全因死亡相關危險因素包括D-二聚體持續暘性、血清肌鈣蛋白水平升高、低血壓、噁性腫瘤、右心功能不全、長期臥床、充血性心力衰竭、心動過速、慢性肺髒疾病、年齡＞ 65歲等.
목적 계통평개폐혈전전새증(PTE)환자전인사망상관위험인소.방법 계통검색PubMed수거고、서문생물의학수거고、중국기간전문수거고、중국생물의학수거고1995년1월지2011년5월공개발표적관우PTE전인사망상관위험인소적연구문헌,병사열각개연구중인용적삼고문헌래보충.관찰성연구(대렬연구화병례대조연구)삼고관우관찰성연구방법학질량평고적건의진행평개;수궤대조연구이용Jadad량표진행평개.응용Cochrane협작망제공적RevMan 5.1연건,진행일치성검험,사용고정효응모형급수궤효응모형진행합병,계산상대위험도(RR),결과이RR치(95％ Cl)표시.결과 최종납입35편문헌,공계19 613례PTE환자,전인사망솔위0.5％～30.0％,평균(10.7±7.6)％,환자전인사망솔적상관위험인소분별위:우심공능불전[2.18(1.64 ～2.89),P =0.000],D-이취체양성[5.19(1.93 ～13.96),P=0.001],혈청기개단백승고[4.01(2.77 ～5.81),P=0.000],저혈압[2.76(1.25～6.09),P=0.010],악성종류[2.65(2.01～ 3.50),P=0.000],충혈성심력쇠갈[1.90(1.62 ～2.22),P=0.000],만성폐장질병[1.40(1.18 ～1.66),P=0.000],심동과속[1.65(1.23 ～2.20),P=0.000],장기와상[1.74(1.36～ 2.21),P=0.000],년령＞65세[1.24(1.13～ 1.37),P=0.000],병차당다인소공존시사망풍험명현증가.결론 PTE환자전인사망상관위험인소포괄D-이취체지속양성、혈청기개단백수평승고、저혈압、악성종류、우심공능불전、장기와상、충혈성심력쇠갈、심동과속、만성폐장질병、년령＞ 65세등.
Objective To evaluate the causes of death and risk factors of pulmonary thromboembolism.Methods Pubmed,English Medical Current Contents,Chinese Conference Data and Chinese Biomedical Database were searched from January 1995 up to May 2011.And the references of these studies were also examined.Observational studies were assessed according to suggestion of quality assessment with references.Randomized control trials (RCT) were assessed with Jadad sacle.Software RevMan 5.1 was used to examin the heterogeneity of trials.The fixed or random effect model was employed to pool the risk ratio and 95 ％ Cl.The results were expressed with risk ratio and 95 ％ CI.Results Thirtyfive studies with a total number of 19 613 cases of pulmonary thromboembolism (PTE) were included for final analysis.The average mortality rate was (10.7 ± 7.6)％ (range 0.5％-30.0％).And the following factors increased the total mortality of pulmonary embolism:right ventricular hypokinesis or dysfunction (2.18(1.64-2.89),P =0.000),elevated D-dimer (5.19(1.93-13.96),P =0.001),elevated cardiac troponin (cTnI) (4.01 (2.77-5.81),P =0.000),hypotension (2.76 (1.25-6.09),P =0.010),malignancy (2.65 (2.01-3.50),P =0.000),congestive heart failure (1.90 (1.62-2.22),P =0.000),chronic lung disease (1.40 (1.18-1.66),P =0.000),tachycardia (1.65 (1.23-2.20),P =0.000),immobility (1.74(1.36-2.21),P =0.000) and age ＞ 65 years (1.24 (1.13-1.37),P =0.000),etc.When multiple factors co-existed,the risk of death became more obvious.Conclusion Elevated D-dimer,elevated cTnI,hypotension,malignancy,right ventricular hypokinesis or dysfunction,immobility,congestive heart failure,tachycardia,chronic lung disease,age ＞ 65 years influence the mortality rate of pulmonary embolism.
