189例急性肺栓塞患者不同发病季节及危险因素的临床分析

发布时间：2018-05-29 10:40

本文选题：肺栓塞 + 季节　；参考：《大连医科大学》2013年硕士论文

【摘要】：目的：探讨大连医科大学附属第二医院收治的189例急性肺栓塞（Acutepulmonary embolism, APE）患者的发病是否存在季节变化规律及其发病危险因素的变化趋势，更好指导临床实践。方法：收集我院2002年~2012年10年间收治的189例确诊为APE的住院患者的临床资料，采用回顾性研究方法对APE的发病季节分布规律及相关危险因素进行分析。结果：10年间我院189例APE患者中，3月、4月APE患者较多，均为20例；计算1月~12月APE发生的构成比约为6.88％~10.58％，但比较12个月各月份之间APE发生的构成比，差异无统计学意义(P0.2)。189例APE患者中，30.69％（58/189）发生在春季，21.16％（40/189）发生在夏季，23.28％（44/189）发生在秋季，，24.87％（47/189）发生在冬季，以春季为多，但四季发病分布比较差异无统计学意义(P0.2)。从年龄来看，≥60岁的125例APE患者以春季发病（40例）较多，而60岁的64例APE患者以秋季发病（20例）较多，但两个年龄组间比较四季分布差异无统计学意义(P0.05)。从性别来看，100例男性APE患者以冬季发病（28例）较多，而89例女性APE患者以春季发病（33例）较多，但不同性别组间比较四季分布差异无统计学意义(P0.05)。从死亡情况来看，住院期间因APE死亡的患者共31例，春季病死率较其他季节高，但四季分布比较差异无统计学意义(P0.05)。189例APE患者中有180例伴有明确的高危因素，其中深静脉血栓形成（DVT）104例、静脉曲张或静脉炎19例、外科手术22例、创伤及骨折13例、心血管疾病60例、慢性肺部疾病19例、恶性肿瘤21例、脑卒中19例、妊娠及围产期1例、介入治疗3例，慢性阻塞性肺疾病(COPD)13例，心力衰竭(心衰)20例，肺炎6例，肾病综合征2例，脓毒症3例，SLE1例，白塞病1例，先天性心脏病1例，真性红细胞增多症1例，溃疡性结肠炎1例。除了外科手术后APE以夏季（12例）较多见(P0.02)外，APE发病伴随其他高危因素的四季分布差异无统计学意义(均P0.05)。肺栓塞主要危险因素依次为DVT、心血管疾病、外科手术、肿瘤疾病、慢性肺部疾病、下肢静脉曲张或静脉炎、创伤及骨折等。心血管疾病在过去10年成为我院APE第二位主要危险因素。结论： 1、2002~2012年这10年间我院APE的发生不存在明显的季节变化规律，APE患者住院病死率与季节变化无明显关系。 2、除了外科手术后APE以夏季较多见以外，伴随其他高危因素的APE发病均无季节差异；过去10年，我院APE前两位的危险因素为深静脉血栓形成、心血管疾病。
[Abstract]:Objective: To investigate the seasonal variation in the incidence of Acutepulmonary embolism (APE) in the Second Affiliated Hospital of Dalian Medical University and the trend of its risk factors, so as to guide the clinical practice better.
Methods: the clinical data of 189 hospitalized patients who were admitted in our hospital during the 10 years of ~2012 in 2002 were collected, and the distribution of APE and related risk factors were analyzed by retrospective study.
Results: among 189 APE patients in our hospital in 10 years, there were more APE patients in March and April, all were 20 cases, and the composition ratio of APE in January ~12 month was about 6.88%~10.58%, but there was no statistically significant difference between the 12 months of each month (P0.2).189 case APE patients, 30.69% (58/189) occurred in spring, 21.16% (40/189) occurred. In the summer, 23.28% (44/189) occurred in the autumn, 24.87% (47/189) occurred in winter, in spring, but there was no significant difference in the distribution of the four seasons (P0.2). From the age, 125 cases of APE patients over 60 years of age were more in spring (40 cases), and 64 cases of APE patients 60 years old were more in autumn (20 cases), but the ratio of two age groups was compared. There was no statistically significant difference in the distribution of the four seasons (P0.05). From the gender point of view, 100 cases of male APE patients had more winter onset (28 cases), and 89 cases of female APE patients were more in spring (33 cases), but there was no statistical difference between the four seasons (P0.05). From the case of death, 31 cases of patients died of APE during hospitalization. The mortality rate in spring was higher than that in other seasons, but there was no significant difference in the distribution of the four seasons (P0.05) there were 180 cases of.189 cases with clear high risk factors, including 104 cases of deep venous thrombosis (DVT), 19 cases of varicosis or phlebitis, 22 cases of surgical operation, 13 cases of traumatic and fracture, 60 cases of cardiovascular disease, 19 cases of chronic lung disease, and evil. There were 21 cases of sexual tumor, 19 cases of stroke, 1 cases of pregnancy and perinatal period, 3 cases of interventional therapy, 13 cases of chronic obstructive pulmonary disease (COPD), 20 cases of heart failure (heart failure), 6 cases of pneumonia, 2 cases of nephrotic syndrome, 3 cases of sepsis, 1 cases of SLE1, 1 cases of Behcet disease, 1 cases of congenital heart disease, 1 cases of true red cythemia, and ulcerative colitis, except APE after surgical operation. In summer (12 cases) (12 cases), there was no significant difference in the distribution of APE with other high risk factors (all P0.05). The major risk factors for pulmonary embolism were DVT, cardiovascular disease, surgery, tumor, chronic lung disease, lower limb veins or phlebitis, trauma and fracture, and so on. Cardiovascular disease in the past 10 years It became the second major risk factor for APE in our hospital.
Conclusion:
There was no obvious seasonal change in the occurrence of APE in our hospital during the past 10 years. There was no obvious relationship between the in-hospital mortality and the seasonal variation of APE patients in 12002~2012.
2, there were no seasonal differences in the incidence of APE associated with other high-risk factors except for APE after surgery. The first two risk factors for the first two in our hospital were deep venous thrombosis and cardiovascular disease in the last 10 years.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563.5

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