肺栓塞的临床特征对比分析

发布时间：2018-03-26 15:14

本文选题：肺栓塞　切入点：临床特征　出处：《石河子大学》2017年硕士论文

【摘要】：目的本研究讨论常见与少见的肺栓塞临床特征;讨论对诊断肺栓塞最有意义的临床特征。方法连续入选2013年1月-2015年7月,疑似肺栓塞并在我院行CT肺血管造影(CTPA)318例,根据肺动脉血管造影诊断分为肺栓塞组(PTE组)及非肺动脉栓塞组(非PTE组),其中肺栓塞组患者155例,非肺栓塞组患者163例,并记录两组临床症状、体征、危险因素、实验室检查、超声心动图及心电图结果。统计分析:采用spss17.0软件包进行统计分析。正态分布计量资料用均数±标准差表示;计量资料用频数(率)表示,组间比较用卡方检验,多因素比较使用二分类Logistic回归,以P0.05位差异有统计学意义。结果155例肺栓塞患者平均年龄(65.84±15.99)岁,常见临床特征为呼吸困难、咳嗽、胸痛,分别占62.58%、60.65%、34.19%。常见体征为呼吸急促、心率加快、发热、下肢不对称性水肿、紫绀,分别占52.25%、29.03%、28.38%、27.74%、21.29%。D-二聚体500μg/L131例(84.51%)。血气分析:氧分压80mm Hg 127例(81.94%),二氧化碳分压35mm Hg 47例(30.32%),PH7.45者57例(36.7%)。血常规:白细胞10×109/L 44例(28.39%),血小板300×109/L 24例(15.48%)。心电图及超声心动图异常包括胸导联T波倒置、S1QIIITIII、右束支传导阻滞、电轴右偏分别占21.05%、12.50%、9.21%和7.89%,右室扩大及肺动脉高压,分别占14.94%和25.32%。常见危险因素为制动、外伤、手术、深静脉血栓栓塞史分别占34.84%、15.48%、12.90%和7.09%。两组比较:PTE组呼吸困难、呼吸加快、发绀、D-二聚体、氧分压、二氧化碳分压、S1QIIITIII、制动、深静脉血栓栓塞史均高于非PE组(P0.05)。二分类Logistic回归分析:呼吸困难及白细胞10×109/L为危险因素;肿瘤、血小板300×109/L为保护因素。结论肺栓塞缺乏临床特异性表现,白细胞计数可为肺栓塞危险分层提供依据,呼吸困难肺栓塞有较高的诊断价值,当患者血气分析出现低氧血症同时伴有低碳酸血症及PH轻度升高时,应警惕肺栓塞的可能。
[Abstract]:The purpose of this study is to discuss the common and uncommon clinical features of pulmonary embolism; discuss the clinical features of the most meaningful for the diagnosis of pulmonary embolism. Methods selected for the January 2013 -2015 year in July, and suspected pulmonary embolism in our hospital CT pulmonary angiography (CTPA) in 318 cases, according to pulmonary artery angiography diagnosis for pulmonary embolism group (PTE group) and non pulmonary embolism group (non PTE group), including 155 cases of pulmonary embolism patients, 163 cases of non pulmonary embolism patients, and record the clinical symptoms, two groups of symptoms, risk factors, laboratory examination, echocardiography and ECG results. Statistical analysis: Statistical analysis was performed using SPSS17.0 software package. The normal distribution of measurement data with standard deviation; frequency measurement data (rate), comparison between groups using chi square test, multiple comparisons using two classification Logistic regression with P0.05 difference was statistically significant. Results 155 cases of patients with pulmonary embolism average Age (65.84 + 15.99) years old, common clinical features were dyspnea, cough, chest pain, accounted for 62.58%, 60.65%, 34.19%. common signs for the shortness of breath, heart rate, fever, limb asymmetry edema, cyanosis, respectively 52.25%, 29.03%, 28.38%, 27.74%, two 21.29%.D- dimer of 500 g/L131 cases (84.51%). Blood gas analysis: oxygen pressure 80mm Hg 127 cases (81.94%), partial pressure of carbon dioxide 35mm Hg 47 cases (30.32%), 57 cases of PH7.45 (36.7%): white blood cells. 10 * 109/L 44 cases (28.39%), platelet 300 * 109/L 24 cases (15.48%). ECG and echocardiographic abnormalities including precordial T wave inversion, S1QIIITIII, right bundle branch block and right axis deviation respectively 21.05%, 12.50%, 9.21% and 7.89%, right ventricular enlargement and pulmonary hypertension, respectively accounted for 14.94% and 25.32%. common risk factors for braking, trauma, surgery, deep vein thrombosis and embolism history accounted for 34.84%, 15.48%, 12.90% and 7.09%. two Group comparison: PTE group of dyspnea, shortness of breath, cyanosis, two D- dimer, PO2, pCO2, S1QIIITIII, brake, deep venous thromboembolism were higher than those in non PE group (P0.05). The regression analysis of two classification Logistic: dyspnea and white blood cells 10 * 109/L as a risk factor; tumor platelet 300 * 109/L protective factors for pulmonary embolism. Conclusion the lack of specific clinical manifestations, white blood cell count can provide the basis for the risk stratification of pulmonary embolism, dyspnea, pulmonary embolism has a high diagnostic value, when the blood gas analysis in patients with hypoxemia accompanied by hypocapnia and elevated PH occurs, should be alert to the probability of pulmonary embolism.

【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.5

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