CAJ | 학술논문

目的:总结老年肺血栓栓塞症的临床特点,提高诊治水平.方法:回顾性分析84例≥60岁的急性肺血栓栓塞症住院患者的临床表现及治疗转归.结果:84例老年急性肺栓塞患者中有44例下肢深静脉血栓形成,占52.4%,发生肺栓塞的基础病疾及危险因素为高血压(43/84)、冠心病(36/84)、脑血管病(28/84)、糖尿病(19/84)、永久性房颤(17/84)、高血脂症(16/84)、充血性心力衰竭(15/84)、肥胖(14/84)等.患者主要表现为呼吸困难(57/84)、咳嗽(30/84)、胸痛(15/84)、心悸(17/84)、晕厥(11/84)、咯血(10/84)、烦躁(4/84)、呼吸心跳骤停(3/84)、下肢不对称肿胀(29/84).75例患者出现低氧血症,62例患者D-二聚体升高,49例患者出现心电图异常,78例经CT肺动脉造影确诊,79例患者进行低分子肝素和华法林抗凝治疗,9例患者给予溶栓治疗,治疗好转73例,死亡11例.结论:PTE的发病率在老年人群中较高,最常见的危险因素为慢性基础疾病和制动,多数患者缺乏特异性症状和体征,积极采取措施预防VTE的发生,做到早期诊断和治疗是降低老年PTE病死率、改善预后的关键.
목적:총결노년폐혈전전새증적림상특점,제고진치수평.방법:회고성분석84례≥60세적급성폐혈전전새증주원환자적림상표현급치료전귀.결과:84례노년급성폐전새환자중유44례하지심정맥혈전형성,점52.4%,발생폐전새적기출병질급위험인소위고혈압(43/84)、관심병(36/84)、뇌혈관병(28/84)、당뇨병(19/84)、영구성방전(17/84)、고혈지증(16/84)、충혈성심력쇠갈(15/84)、비반(14/84)등.환자주요표현위호흡곤난(57/84)、해수(30/84)、흉통(15/84)、심계(17/84)、훈궐(11/84)、각혈(10/84)、번조(4/84)、호흡심도취정(3/84)、하지불대칭종창(29/84).75례환자출현저양혈증,62례환자D-이취체승고,49례환자출현심전도이상,78례경CT폐동맥조영학진,79례환자진행저분자간소화화법림항응치료,9례환자급여용전치료,치료호전73례,사망11례.결론:PTE적발병솔재노년인군중교고,최상견적위험인소위만성기출질병화제동,다수환자결핍특이성증상화체정,적겁채취조시예방VTE적발생,주도조기진단화치료시강저노년PTE병사솔、개선예후적관건.
Objective:To summarize the clinical characteristics of acute pulmonary thromboembolism in elderly patients,in order to improve the level of diagnosis and treatment.Methods:Clinical feature,theatment and prognosis of 84 cases aged over 60 yrars old with acute pulmonary thromboembolism were analyzed retrospectively.Results:Deep vein thromboembolism was found in 84 cases. Hypertension(43/84),Coronary heart disease (36/84),Cerebrovascular disease (28/84),diabetes(19/84),Permanent af(17/84),hyperlipidem ia(16/84),Congestive heart failure(15/84)and obesity(14/84) were the most common risk factors.The common symptoms were dyspnea (57/84),cough(30/84),chest pain(15/84),palpitation(17/84),faint(11/84),haemoptysis(10/84),fidgety(4/84),Breathing cardiac arrest(3/84), lower limb asymmetric swelling (29/84).75 patients appeared hypoxemia,62 patients d-dimer increases, 49 cases (ecg abnormalities, 78 cases of the CT pulmonary angiography diagnosis, 79 patients of low molecular heparin and warfarin anticoagulant therapy, 9 patients give thrombolysis treatment, the treatment improved 73 cases, 11 cases death.Conclusion:The incidence of PTE in older crowd is higher, the most common risk factors for chronic basic diseases and brake, the majority of the patient lacks specific symptoms and signs of VTE for high-risk patients take positive prevention measures, and do early diagnosis and early treatment is to reduce the old PTE mortality and improve the prognosis of the key.