摘要
目的对肺血栓栓塞症(PTE)患者临床特征、诊治情况进行总结,探讨影响PTE患者病情危险程度的相关因素。方法收集济宁医学院附属医院2019年1月至2020年12月确诊的PTE患者222例的临床资料进行回顾性分析,依据急性PTE诊断和治疗相关指南分为低危组117例和中高危组105例,行单因素、多因素分析,筛选影响PTE病情危险程度的相关因素。结果PTE临床表现复杂多样,呼吸困难是患者最常见的临床症状(63.06%),同时出现呼吸困难、胸痛、咯血三联征者仅4.05%。中高危组D二聚体、C反应蛋白、白细胞计数、凝血酶原时间、丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、血尿素氮(BUN)测定值均高于低危组(P<0.05)。CT肺动脉成像(CTPA)可清楚显示叶、段及亚段级肺动脉内栓子,肺叶动脉栓塞发病率最高(68.47%),中高危组肺动脉主干栓塞发生率明显高于低危组(43.81%vs 9.40%,P<0.01)。多数PTE患者合并下肢肌间静脉和(或)深静脉血栓。95.50%的PTE患者接受了抗凝治疗,3.15%的患者进行了溶栓治疗,多数预后良好,院内死亡率1.35%。Logistic多因素回归分析显示,指脉氧高是PTE患者病情危重的独立保护因素,AST和BUN高、肺动脉主干栓塞是其独立危险因素(P<0.05)。结论PTE临床表现复杂多样,指脉氧、AST、BUN水平和肺动脉主干栓塞是影响PTE患者病情危险程度的独立因素。
Objective To summarize the clinical features,diagnosis and treatment of patients with pulmonary thromboembolism(PTE)to explore the related risk factors affecting the severity of PTE patients.Methods A retrospective analysis was performed on the clinical data of 222 PTE patients in the Affiliated Hospital of Jining Medical University from January 2019 to December 2020.According to guidelines on the diagnosis and management of acute PTE,the patients were divided into low-risk group(n=117)and medium-high-risk group(n=105).Univariate and multivariate analysis were used to screen the relevant factors affecting the severity of PTE.Results The clinical manifestations of PTE were complex and varied.Dyspnea was the most common clinical symptom of the patients(63.06%),and only 4.05%of patients had the triad of dyspnea,chest pain and hemoptysis simultaneously.The levels of D-dimer,C-reactive protein,white blood cell count,prothrombin time(PT),alanine aminotransferase(ALT),aspartate aminotransferase(AST)and blood urea nitrogen(BUN)in medium-high-risk group were significantly higher than those in low-risk group(P<0.05).CT pulmonary angiography(CTPA)clearly showed the incidence of lobar pulmonary artery embolism was the highest,accounting for 68.47%.The incidence of pulmonary artery trunk embolism in medium-high-risk group was significantly higher than that in low-risk group(43.81%vs 9.40%,P<0.01).Most PTE patients were complicated with lower limb intermuscular vein and/or deep-vein thrombosis.Anticoagulant therapy was performed in 95.50%of patients,and thrombolytic therapy was conducted in 3.15%of patients,with good prognosis.The in-hospital mortality rate was 1.35%.Logistic multivariate regression analysis showed that high pulse oxygen saturation was an independent protective factor for the severity of PTE,and high AST and BUN levels and pulmonary artery trunk embolism were the independent risk factors for the severity of PTE(P<0.05).Conclusion The clinical manifestations of PTE are complex and varied.Pulse oxygen saturation,AST and BUN levels and pulmonary artery trunk embolism are the independent factors affecting the severity of PTE patients.
作者
肖子亚
王新艳
李勇
田浩
赵红燕
任尚娴
孟凡亮
李治红
XIAO Ziya;WANG Xinyan;LI Yong;TIAN Hao;ZHAO Hongyan;REN Shangxian;MENG Fanliang;LI Zhihong(Department of Emergency,Affiliated Hospital of Jining Medical University,Jining,Shandong 272029,China)
出处
《中国临床研究》
CAS
2023年第4期505-509,共5页
Chinese Journal of Clinical Research
基金
山东省医药卫生科技发展计划资助项目(202010000964)。
关键词
肺血栓栓塞症
临床特征
危险分层
呼吸困难
CT肺动脉成像
肺叶动脉栓塞
Pulmonary thromboembolism
Clinical features
Risk stratification
Dyspnea
CT pulmonary angiography
Lobar pulmonary artery embolism
