肺血栓栓塞的危险因素和临床分析

发布时间：2018-05-11 09:35

  本文选题：肺血栓栓塞症 + 危险因素　； 参考：《山东中医药大学》2012年硕士论文

【摘要】：目的:分析肺血栓栓塞症（PTE）的危险因素、临床表现、实验室检查,方法和预后，提高对其的认识和诊断水平，从而进一步提高治愈率，减少误诊率和漏诊率。 方法：回顾性分析2009年10月至2012年4月88例确诊为肺血栓栓塞患者的临床资料。 结果：1.96.5%的患者存在高危因素，最常见的危险因素或基础疾病为下肢深静脉血栓形成/曲张（47.7%），其次为冠心病（39.7%），高血压（34.1%），感染（30.7%），COPD（22.7%），恶性肿瘤（18.1%），手术（17%），糖尿病（14.7%），骨折（12.5%），结缔组织病8例（9%），甲亢7例（7.96%），长期卧床者2例（2.3%）。 2.最常见的症状为呼吸困难61例（69.3%），其次为胸痛30例（34.1%），咳嗽26例（29.5%），咯血6例（6.8%），晕厥2例（2.3%），，呼吸困难、胸痛、咯血同时出现（肺梗死）者5例（5.7%）。最常见的体征为肺部罗音22例（25%），其次为胸腔积液12例（13.6%），，紫绀11例（12.5%）， P2亢进10例（11.4%），下肢肿胀10例（11.4%），发热7例（8.0%），皮肤瘀斑1例（1.14%）。 3.辅助检查：（1）实验室检查：60例患者行D-二聚体检查，其中45例500μg|L（75%）。73例患者行血气分析检查,52例(71.2%),动脉血氧分压(PaO2)下降60mmHg;50例(68.4%)动脉血二氧分压(Pa CO2)下降35mmHg，，血氧饱和度(Sa02)＜95%者69例(94.5%)。30例患者行血沉检测，其中24例（80%）高于正常。（2）超声心动图：其中有62例PTE间接征象，肺动脉压力增高(35mmHg)共50例,占56.2%,其中轻度肺动脉高压(36~50mmHg)18例,占20.2%,中度肺动脉高压(50~70mmHg)17例,占19.1%,重度肺动脉高压(70mmHg)15例,占16.9%。（3）心电图：60例有不同程度变化，窦性心动过速33例（55%），ST－T改变4例（6.7%），SⅠQⅢTⅢ18例(30%),房颤5例（8.3%），右束支传导阻滞3例（5%）。（4）胸部X线和下肢血管彩超X线胸片示胸腔积液12例（13.6），58例PTE患者行下肢静脉超声检查,有35例（60.3%）下肢深静脉血栓形成。 4.治疗和预后88例患者中治愈37例，显效22例，好转17例，死亡1例，无效3例。 结论：肺血栓栓塞的临床表现多种多样，易造成漏诊和误诊，因此提高对肺血栓栓塞的认识，进行早期干预治疗，可降低死亡率。
[Abstract]:Objective: to analyze the risk factors, clinical manifestations, laboratory examination, methods and prognosis of pulmonary thromboembolism (PTE), and to improve the understanding and diagnosis of PTEs, so as to further improve the cure rate and reduce the misdiagnosis rate and missed diagnosis rate. Methods: the clinical data of 88 patients with pulmonary thromboembolism from October 2009 to April 2012 were retrospectively analyzed. Results 1.96. 5% of the patients had high risk factors. The most common risk factors or underlying diseases were deep venous thrombosis / varices of the lower extremities 47.7am, coronary heart disease 39.7m, hypertension 34.1m, infection 30.77.7m, malignant tumor 18.1C, surgical operation 175.The incidence of diabetes 14.7m, fracture 12.5m, connective tissue disease 8 cases, hyperthyroidism 7.96m 7 cases, and chronic bed rest 2 cases with diabetes 2.30.The most common risk factors or basic diseases were: deep vein thrombosis / varices 47.7am, coronary heart disease 39.7%, hyperthyroidism 7 cases, hyperthyroidism 7.967%, and chronic bed rest 2 cases. 2. The most common symptoms were dyspnea in 61 cases (69.3%), chest pain in 30 cases (34.1%), cough in 26 cases (29.5m), hemoptysis in 6 cases (6.8%), syncope in 2 cases (2.3%), dyspnea, chest pain and hemoptysis (pulmonary infarction) in 5 cases. The most common signs were lung rales in 22 cases, pleural effusion in 12 cases, cyanosis in 11 cases, P 2 in 10 cases, in 10 cases of swelling of lower limbs, in 7 cases of fever, and in 1 case of ecchymosis, 1 case of ecchymosis, and 1 case of ecchymosis. 3. Assistant examination: 1) Laboratory examination: 60 patients underwent D- dimer examination. Among them, 45 patients (500 渭 g / L) and 73 patients were examined by blood gas analysis. 52 patients were found to have a blood gas analysis and 52 patients had a decrease of Pao 2 (60 mm Hg2) and 50 patients had a decrease of 60 mm Hg2 (P < 68.4 mm). The arterial partial pressure of oxygen (Pao 2) was decreased by 35 mm Hgn. The blood oxygen saturation (Sa02) was less than 95%. 69 cases (94.55%) were examined for erythrocyte sedimentation rate (ESR). Among them, there were 62 cases with indirect signs of PTE and 35 mm Hg of pulmonary hypertension (56.2 mm), of which 18 cases (20.2mm) were mild pulmonary hypertension, 17 cases (19.1mm) were moderate pulmonary hypertension, 15 cases were severe pulmonary hypertension (70mm Hgg), 18 cases (20.2mm) were mild pulmonary hypertension, 17 cases (19.1mm) were moderate pulmonary hypertension. The electrocardiogram of 60 cases has varying degrees. ST-T changes in 33 cases of sinus tachycardia (n = 33) and changes of ST-T in 4 cases (6. 7) including 30 cases with S 鈪

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