重庆地区肺栓塞患者临床资料回顾性调查分析

发布时间：2018-02-04 01:54

本文关键词： 肺栓塞调查治疗　出处：《重庆医科大学学报》2017年10期 　论文类型：期刊论文

【摘要】：目的:了解重庆地区各级医院近10年肺栓塞诊治情况,为进一步提高及规范肺栓塞的预防、诊断和治疗提供依据。方法:收集重庆地区31家医院2003至2012年期间诊断为肺栓塞患者的临床资料,进行回顾性调查研究分析。结果:(1)31家医院共纳入336例患者,其中确诊195例,临床诊断141例,死亡105例。(2)主要合并基础疾病为高血压、创伤及手术、制动、肺癌、冠心病、肺部感染等。(3)主要临床表现为呼吸困难、咳嗽、胸痛、心悸、咳痰、晕厥。(4)非老年组确诊率比老年组更高,差异有统计学意义(67.14%vs.51.03%,P=0.003);非老年组死亡率低于老年组,差异有统计学意义(36.60%vs.24.29%,P=0.017)。(5)2008至2012年肺栓塞确诊率比2003至2007年肺栓塞更高,差异有统计学意义(62.23%vs.38.60%,P=0.000);2008至2012年肺栓塞患者死亡率低于2003至2007年肺栓塞患者死亡率,差异有统计学意义(49.12%vs.27.34%,P=0.000)。(6)三级医院确诊率比二级医院更高,差异有统计学意义(59.81%vs.31.58%,P=0.015);三级医院与二级医院患者死亡率比较差异无统计学意义(31.01%vs.36.84%,P=0.595)。(7)干预组与未干预组比较,未干预组死亡率更高,差异有统计学意义(14.53%vs.69.61%,P=0.000)。(8)多因素回归分析表明确诊率的独立因素为年龄(优势比:2.177,95%CI=1.356~3.494),时间(优势比:3.175,95%CI=1.720~5.860),医院等级(优势比:0.262,95%CI=0.094~0.728)。死亡率的独立危险因素为时间(优势比:1.817,95%CI=0.895~3.687)和有无干预措施(优势比:0.078,95%CI=0.044~0.137)。结论:重庆地区大部分医院医务人员肺栓塞诊断意识逐年有所提高,但筛查肺栓塞高危患者及肺栓塞预防意识差。三级医院主要靠电子计算机断层扫描肺动脉造影(computed tomography pulmonary angiography,CTPA)确诊肺栓塞,各级医院诊断肺栓塞以临床综合诊断为主,确诊率低,但三级医院确诊率高于二级医院,非老年患者的确诊率高于老年患者。重庆地区肺栓塞的诊断及治疗肺栓塞欠规范,死亡率高。2003至2007年间死亡率高于2008至2012年,及时干预和治疗可降低死亡率。因此,重庆地区各医级院肺栓塞诊断及治疗水平有待大幅提高,以此降低肺栓塞的死亡率,改善预后。
[Abstract]:Objective: to investigate the diagnosis and treatment of pulmonary embolism (PE) in Chongqing hospitals in recent 10 years in order to further improve and standardize the prevention of pulmonary embolism. Methods: the clinical data of 31 hospitals in Chongqing from 2003 to 2012 were collected. Results 336 patients were included in 31 hospitals, 195 of them were diagnosed and 141 were clinically diagnosed. The main clinical manifestations of death were hypertension, trauma and operation, immobilization, lung cancer, coronary heart disease, pulmonary infection, etc.) the main clinical manifestations were dyspnea, cough, chest pain and palpitation. The diagnosis rate of non-senile group was higher than that of the elderly group, the difference was statistically significant (67.14vs.51.03P 0.003); The mortality rate in the non-elderly group was lower than that in the elderly group, and the difference was statistically significant (36.60 vs 24.29%). The diagnosis rate of pulmonary embolism from 2008 to 2012 was higher than that from 2003 to 2007, and the difference was statistically significant (62.23vs.38.60%). P0. 000; The mortality rate of pulmonary embolism patients from 2008 to 2012 was lower than that of patients with pulmonary embolism from 2003 to 2007, and the difference was statistically significant (49.12% vs 27.34%). The diagnosis rate of the third grade hospital was higher than that of the second class hospital, and the difference was 59.81vs.31.58. There was no significant difference in the mortality rate between the tertiary hospital and the second class hospital. There was no significant difference between the intervention group and the non-intervention group. The mortality rate of non-intervention group was higher than that of non-intervention group, the difference was statistically significant (14.53 vs 69.61%). The multivariate regression analysis showed that the independent factor of diagnosis rate was age (odds ratio was 2.177 / 95CI1.356 / 3.494). Time (advantage: 3.175 / 95) 1.720 / 5.860 and hospital / hospital / hospital / hospital / hospital / hospital / hospital / hospital / hospital / hospital / hospital / hospital / hospital / hospital / hospital / hospital / hospital / hospital / hospital level. The independent risk factors of mortality were time (odds ratio: 1. 817). 95 CII 0.895 / 3.687) and with or without intervention (odds ratio: 0.078). Conclusion: the diagnostic consciousness of pulmonary embolism in most hospitals in Chongqing area has been improved year by year. But the screening of high risk patients for pulmonary embolism and the awareness of prevention of pulmonary embolism were poor. Computed tomography pulmonary angiography. CTPA was used to diagnose pulmonary embolism. The diagnosis rate of pulmonary embolism in hospitals at all levels was mainly clinical comprehensive diagnosis, but the rate of diagnosis in tertiary hospitals was higher than that in second-level hospitals. The diagnosis rate of non-elderly patients was higher than that of elderly patients. The diagnosis and treatment of pulmonary embolism in Chongqing area was substandard, and the mortality rate between 2003 and 2007 was higher than that from 2008 to 2012. Therefore, the diagnosis and treatment level of pulmonary embolism in various hospitals in Chongqing area should be greatly improved, so as to reduce the mortality rate of pulmonary embolism and improve the prognosis.
【作者单位】：重庆医科大学附属第一医院呼吸与危重症医学科;重庆市荣昌区人民医院呼吸内科;第三军医大学附属大坪医院野战外科研究所呼吸内科;
【基金】：重庆市科委资助项目(编号:cstc2015jcsf1009-5) 重庆市卫计委资助项目(编号:2015jstg006、20142007);重庆市卫计委资助重点资助项目(编号:2015ZDXM001)
【分类号】：R563.5
【正文快照】： 3.第三军医大学附属大坪医院野战外科研究所呼吸内科,重庆400042)目前学术界一致认为,肺栓塞已成为临床常见病、多发病,完全颠覆了以往由于诊断意识落后、诊断能力低下造成肺栓塞为罕见病的误区。在美国,其发病率仅次于冠心病、脑卒中,且在临床住院患者死亡病因中,肺栓塞是主

【相似文献】