70例肺栓塞的临床特征分析
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摘要
目的对70例肺栓塞患者危险因素,临床表现,实验室检查,影像学特征及治疗疗效等临床特征进行分析。方法收集2014年1月至2018年3月于安徽医科大学第二附属医院住院确诊的70例肺栓塞病例,回顾性分析其危险因素,临床表现,实验室检查,简化的Wells评分,修正的Geneva评分,影像学特点,危险分层以及相关的治疗方案等临床特征。结果本组患者的主要危险因素包括制动(38. 6%)。常见的临床表现有胸闷(41. 8%)、胸痛(11. 2%)、咯血(或痰中带血,11. 2%)、咳嗽咳痰(9. 2%)、呼吸困难(8. 2%)、晕厥(6. 1%)等。年龄矫正的D-二聚体阴性4例(5. 7%),阳性66例(94. 3%)。心电图示窦性心动过速23例(32. 9%),SIQIIITIII 8例(11. 4%),不完全性或完全性右束支阻滞6例(8. 6%),房颤8例(11. 4%)。超声心动图提示肺动脉高压占46. 2%,右室增大占26. 9%。Wells评分≥2分患者62例(88. 6%)。Geneva评分≥3分患者64例(91. 4%)。17例静脉溶栓治疗,51例抗凝治疗,62例好转出院。结论肺栓塞临床表现具有多样性,实验室检查缺乏特异性,需结合临床表现和多种检查手段,综合分析评估,减少漏诊和误诊。
Objective To analyze the risk factors,clinical features,laboratory tests,imaging characteristics and therapeutic effects of 70 patients with pulmonary embolism. Methods 70 patients diagnosed as pulmonary embolism were collected at the second hospital of Anhui Medical University from January,2014 to March,2018,and their risk factors,clinical manifestations,laboratory tests,simplified wells scores,revised Geneva scores,imaging features,risk stratification and related treatment plans were retrospectively analyzed. Results The primary risk factor for this group was braking( 38. 6%). The common clinical features included chest distress( 41. 8%),chest pain( 11. 2%),hemoptysis( or bloody sputum,11. 2%),cough and expectoration( 9. 2%),dyspnea( 8. 2%),syncope( 6. 1%). Age-corrected D-dimer was negative in 4 cases( 5. 7%) and positive in 66 cases( 94. 3%). ECG showed sinus tachycardia in 23 cases( 32. 9%),SIQIIITIII in 8 cases( 11. 4%),incomplete or complete right bundle branch block in 6 cases( 8. 6%),and atrial fibrillation in 8 cases( 11. 4%). The ultrasonic cardiogram showed that pulmonary hypertension accounted for 46. 2% and right ventricular enlargement for 26. 9%. 62 patients were with wells score ≥2( 88. 6%),and 64 patients were with Geneva score ≥3( 91. 4 %). 17 patients received intravenous thrombolytic therapy,51 received anticoagulation therapy,and 62 recovered and were discharged from hospital. Conclusion The clinical manifestations of pulmonary embolism are diverse,and the laboratory examination lacks specificity. It needs to be combined with clinical manifestations and various examination methods to comprehensively analyze and evaluate so as to reduce missed diagnosis and misdiagnosis.
Objective To analyze the risk factors,clinical features,laboratory tests,imaging characteristics and therapeutic effects of 70 patients with pulmonary embolism. Methods 70 patients diagnosed as pulmonary embolism were collected at the second hospital of Anhui Medical University from January,2014 to March,2018,and their risk factors,clinical manifestations,laboratory tests,simplified wells scores,revised Geneva scores,imaging features,risk stratification and related treatment plans were retrospectively analyzed. Results The primary risk factor for this group was braking( 38. 6%). The common clinical features included chest distress( 41. 8%),chest pain( 11. 2%),hemoptysis( or bloody sputum,11. 2%),cough and expectoration( 9. 2%),dyspnea( 8. 2%),syncope( 6. 1%). Age-corrected D-dimer was negative in 4 cases( 5. 7%) and positive in 66 cases( 94. 3%). ECG showed sinus tachycardia in 23 cases( 32. 9%),SIQIIITIII in 8 cases( 11. 4%),incomplete or complete right bundle branch block in 6 cases( 8. 6%),and atrial fibrillation in 8 cases( 11. 4%). The ultrasonic cardiogram showed that pulmonary hypertension accounted for 46. 2% and right ventricular enlargement for 26. 9%. 62 patients were with wells score ≥2( 88. 6%),and 64 patients were with Geneva score ≥3( 91. 4 %). 17 patients received intravenous thrombolytic therapy,51 received anticoagulation therapy,and 62 recovered and were discharged from hospital. Conclusion The clinical manifestations of pulmonary embolism are diverse,and the laboratory examination lacks specificity. It needs to be combined with clinical manifestations and various examination methods to comprehensively analyze and evaluate so as to reduce missed diagnosis and misdiagnosis.
引文
[1]中华医学会呼吸病学分会肺栓塞与肺血管病学组,中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会,全国肺栓塞与肺血管病防治协作组.肺血栓栓塞症诊治与预防指南[S].中华医学杂志,2018,98(14):1060-1087.
[2]WELLS P S,ANDERSON D R,RODGER M,et al.Derivation of a simple clinical model to categorize patients probability of pulmonary embolism:increasing the models,utility with the SimpliRED D-dimer[J].Thromb Haemost,2000,83(3):416-420.
[3]LE GAL G,RIGHINI M,ROY P M,et al.Prediction of pulmonary embolism in the emergency department:the revised Geneva score[J].Ann Intern Med,2006,144(3):165-171.
[4]SHIRAEV T P,OMARI A,RUSHWORTH R L.Trends in pulmonary embolism morbidity and mortality in Australia[J].Thromb Res,2013,132(1):19-25.
[5]季惠丽.肺栓塞误诊分析[J].浙江临床医学,2017,19(9):1741-1742.
[6]孙源君,WALEED K B,夏云龙.心房颤动与肺栓塞的关系及治疗[J].中国循环杂志,2018,33(3):307-309.
[7]孙涛,于连凤.肺栓塞59例诊断与治疗的回顾性分析[J].临床和实验医学杂志,2004,3(4):227-229.
[8]李文玲,王占鳌,田兴仓,等.探讨Wells评分,Geneva评分及改良Geneva评分应用于国内肺血栓栓塞症患者的诊断价值[J].中国现代医学杂志,2015,25(17):51-55.
[9]MONREAL M,LóPEZ-JIMéNEZ L.Pulmonary embolism in patients over 90 years of age[J].Curr Opin Pulm Med,2010,16(5):432-436.
[10]王4,张放.32例肺栓塞临床分析[J].临床肺科杂志,2008,13(2):177-178.
[11]朱平,陈霞,柴虹,等.78例肺栓塞的临床特征与诊治[J].实用医院临床杂志,2017,14(2):58-61.
[2]WELLS P S,ANDERSON D R,RODGER M,et al.Derivation of a simple clinical model to categorize patients probability of pulmonary embolism:increasing the models,utility with the SimpliRED D-dimer[J].Thromb Haemost,2000,83(3):416-420.
[3]LE GAL G,RIGHINI M,ROY P M,et al.Prediction of pulmonary embolism in the emergency department:the revised Geneva score[J].Ann Intern Med,2006,144(3):165-171.
[4]SHIRAEV T P,OMARI A,RUSHWORTH R L.Trends in pulmonary embolism morbidity and mortality in Australia[J].Thromb Res,2013,132(1):19-25.
[5]季惠丽.肺栓塞误诊分析[J].浙江临床医学,2017,19(9):1741-1742.
[6]孙源君,WALEED K B,夏云龙.心房颤动与肺栓塞的关系及治疗[J].中国循环杂志,2018,33(3):307-309.
[7]孙涛,于连凤.肺栓塞59例诊断与治疗的回顾性分析[J].临床和实验医学杂志,2004,3(4):227-229.
[8]李文玲,王占鳌,田兴仓,等.探讨Wells评分,Geneva评分及改良Geneva评分应用于国内肺血栓栓塞症患者的诊断价值[J].中国现代医学杂志,2015,25(17):51-55.
[9]MONREAL M,LóPEZ-JIMéNEZ L.Pulmonary embolism in patients over 90 years of age[J].Curr Opin Pulm Med,2010,16(5):432-436.
[10]王4,张放.32例肺栓塞临床分析[J].临床肺科杂志,2008,13(2):177-178.
[11]朱平,陈霞,柴虹,等.78例肺栓塞的临床特征与诊治[J].实用医院临床杂志,2017,14(2):58-61.