摘要
目的探讨急性肺栓塞(acute pulmonary embolism,APE)的临床特点,分析诊断及误诊原因及改进方法。方法对2008年1月—2010年6月住院的76例APE患者的易患因素、临床表现、实验室检查、治疗方法及转归进行回顾性分析。结果 (1)60～79岁APE患者所占的比例最高,多数患者有危险因素。APE初诊误诊率为38.2%,被误诊的21例经Geneva评分有86.2%为中度或高度肺栓塞可能。(2)APE患者临床表现多样,最常见症状为呼吸困难、胸痛和晕厥;心电图常见表现为SⅠQⅢTⅢ(73.7%)、窦速(42.1%)和胸前导联(V1～V4)T波倒置(36.8%);超声心动图检查有58.8%右房室瓣反流、48.5%肺动脉高压、39.7%右室扩大;血气分析示低氧血症者占55.7%;D-二聚体(D-dimer)升高为86.1%。(3)76例患者中接受溶栓治疗32例,死亡1例,无严重出血事件。结论 APE发病与易患因素相关,临床表现多样,容易误诊,Geneva评分对疑似APE患者的鉴别诊断有实用价值;对高危APE病例溶栓治疗安全有效。
Objective To study the clinical characteristics of acute pulmonary embolism （APE）, and to analyze the procedure of its correct diagnosis, reasons for misdiagnosis and how to improve the diagnosis. Methods The predisposing factors, clinical presentations, laboratory examinations, treatment and outcome of 76 inpatients with APE in Xuanwu Hospital from Janu- ary 2008 to June 2010 were analyzed retrospectively. Results The prevalence of APE was higher at the age of 60 - 79 years, most of the patients had the risk factors related to PE. The misdiagnosis rate was 38. 2% at the first diagnosis. Among the 21 misdiagnosed patients Geneva scores showed that 86. 2% were of moderate or high possibility to have APE. The symptoms of APE were varied, the most common symptoms were dyspnea, chest pain, and syncope. The common ECG findings of APE were the S I Qlll Tm pattern （73.7%）, and T wave inversion in precordial leads V1 through V4 （36. 8% ）. There were 58.8% patients who had right ventrieular enlargement on ultrasound cardiogram, 48.5% who had pulmonary hypertension, and 39. 7% who had enlargement of right ventricle. Blood gas analysis showed hypoxemia in 55.7% , increase of D - dimer in 86. 1%. Among the 76 patients, 32 patients were administered thrombolytics, there was one death and no severe haemorrhagia phenomenon during thrombolysis therapy. Conclusion The incidence of APE is related to the predisposing factors, the manifestations are many and varied so misdiagnosis is very likely. Geneva score for suspicious APE is helpful for differential diagnosis. Thrombolysis therapy is effective and safe in high -risk APE.
出处
《中国全科医学》
CAS
CSCD
北大核心
2011年第1期96-98,共3页
Chinese General Practice
