肺血栓栓塞患者再栓塞相关因素研究

发布时间：2018-03-07 02:39

本文选题：肺栓塞　切入点：肺血栓栓塞　出处：《河北医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的:再栓塞是肺血栓栓塞患者主要不良预后事件之一，关于再栓塞率及相关危险因素目前尚无统一结论，本研究通过长期追踪观察临床确诊的肺栓塞患者，旨在了解再栓塞发生情况及相关危险因素。方法:收集1998年1月至2011年6月在河北医科大学第二医院住院期间经螺旋CT肺血管成像(CTPA)或肺通气灌注扫描确诊的肺血栓栓塞患者的病例资料，并进行平均28个月（确诊之日至161个月）的随访调查，分析再栓塞发生情况。应用单因素分析（t检验或χ2检验）时选择P＜0.10的变量进入回归模型进一步分析，对可能有意义的因素行多因素非条件logistic回归分析，寻找再栓塞危险因素。结果:在161个月内接受随访的385例肺栓塞患者中48例发生再栓塞，，再栓塞发生的时间构成比依次为：第1年50.0%（24例），第2年22.92%（11例），第3年10.42%（5例），第4年5.41%（2例），第5年5.41%（2例），第6年5.41%（2例），第7年2.70%（1例），第8年2.70%（1例）。单因素分析（P＜0.10）显示： D-dimer持续阳性、右心功能不全、特发性PTE、短疗程抗凝治疗（＜3月）、年龄＞65岁、吸烟、高血压、下肢深静脉血栓、低氧血症等与再栓塞具有相关性（P＜0.05）；而多因素非条件logistic回归分析发现仅D-dimer持续阳性（OR=28.257）、右心功能不全（OR=14.806）、特发性PTE（OR=7.839）、短疗程抗凝治疗（＜3月，OR=5.464）、年龄＞65岁（OR=9.518）、吸烟（OR=5.464）是发生再栓塞的独立危险因素（P＜0.05）；并且存在两个以上因素者再栓塞率明显增高，是单因素者的近3倍（87.50%vs21.66%，P=0.000）。结论:肺栓塞患者在发病1年内再栓塞风险最高，以后随着时间的推移再栓塞发生率逐年下降，并且在所有肺栓塞的危险因素中，D-dimer持续阳性、右心功能不全、特发性PTE、短疗程抗凝治疗（＜3月）、年龄＞65岁、吸烟是发生再栓塞的独立危险因素。
[Abstract]:Objective: re embolism is one of the main adverse prognostic events in patients with pulmonary thromboembolism. There is no unified conclusion on the rate of re embolism and related risk factors. To understand the occurrence of re-embolism and related risk factors. Methods: the data of patients with pulmonary thromboembolism diagnosed by spiral CT pulmonary angiography (CTPA) or pulmonary ventilation perfusion scan during hospitalization in the second Hospital of Hebei Medical University from January 1998 to June 2011 were collected. An average of 28 months (from the date of diagnosis to 161 months) was followed up to analyze the occurrence of re embolism. The variables P < 0. 10 were selected to enter the regression model for further analysis by using single factor analysis or 蠂 2 test. Multivariate non-conditional logistic regression analysis was performed to find the risk factors for re-embolization. Results: 48 of 385 patients with pulmonary embolism were followed up within 161 months. The time composition ratio of reembolism occurred in the following order: 50.024 cases in the first year, 22.92 cases in the second year, 10.42 cases in the third year, 5.41 cases in the fourth year, 2 cases in the fifth year, 2 cases in the sixth year, 2.70 cases in the 7th year, and 2.70% in the 8th year (P < 0.10). D-dimer continues to be positive, Right ventricular insufficiency, idiopathic PTEs, short course of anticoagulant therapy (< March, age > 65, smoking, hypertension, deep venous thrombosis of lower extremity). The multivariate conditional logistic regression analysis showed that only D-dimer continued positive ORT 28.257, right ventricular insufficiency 14.806, idiopathic PTER 7.8399A, short course anticoagulant therapy (< March OR5.464, age > 65 years, OR9.518, smoking OR5.464). The independent risk factor was P < 0.05, and the re-embolization rate was significantly higher in the patients with more than two factors. Nearly 3 times as much as that of single factor, 87.50% vs 21.66. Conclusion: the risk of re embolization in patients with pulmonary embolism is the highest within 1 year, and the incidence of re embolization decreases year by year with the passage of time, and D-dimer remains positive in all the risk factors of pulmonary embolism, right ventricular insufficiency. Idiopathic PTEs, short course anticoagulant therapy (< March, age > 65), smoking was an independent risk factor for re-embolism.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R563.5

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