急性肺栓塞临床病例分析

发布时间：2018-06-29 05:08

本文选题：急性肺栓塞 + 诊断　；参考：《石河子大学》2013年硕士论文

【摘要】：目的：分析急性肺栓塞（acute pulmonary embolism，APE）的临床特点，并观察溶栓和抗凝治疗的临床安全性，以减少误诊率和漏诊率，及时给予安全有效的治疗措施。方法：采用回顾性分析方法，收集新疆石河子大学医学院第一附属医院2008年1月-2012年2月收治的52例急性肺栓塞的住院患者的一般资料、住院时间、易患因素、临床表现、实验室及影像学检查结果以及治疗方法与转归等临床资料，统计各临床资料的发生频率，并应用统计学方法分析不同治疗方法的治疗效果以及预后情况。结果： 1.老年患者（60岁）、吸烟、下肢静脉疾病、手术、高血压病、冠心病是肺栓塞常见的易患因素，，两个以上危险因素的有40例。 2.最常见症状为呼吸困难，其次为胸痛、咯血和咳嗽，其中咯血患者11例（21.2%），无大咯血发生。50%以上患者查体可发现呼吸急促和心动过速。12例患者(22.2%)出现DVT（deep venous thrombosis）征。另外，典型的呼吸困难、咯血、胸痛三联征只见于5例（9.6%）APE患者。 3.动脉血气分析发现低氧血症（（PaO_210.7kPa/80mmHg）（即氧分压80mmHg）42例(93.3%)。 4.免疫比浊法定量检验，其中45例（95.7%）D-二聚体结果0.5ug/ml。 5.X线胸片有继发肺组织改变的96%。心电图有特异性改变典型的S_IQ_(III)T_(III)征6.1%，窦性心动过速阳性率为61.2%，胸导联T波倒置28.6%，RBBB/IRBBB6.1%。 6.超声心动图发现肺动脉高压13例（31.0%)，右室壁运动减退12例(28.6%)，三尖瓣返流15例（35.7%），右心室扩大7例（16.7%)，心包积液1例（2.4%)。多普勒血管超声发现12例静脉血栓形成。 7.CT肺动脉造影（computed tomography pulmonary angiography，CTPA）48例发现肺动脉和/或分支充盈缺损的改变，其中右肺下叶47例，上叶40例，中叶29例，左肺下叶38例，上叶32例。 8.溶栓治疗有效率为71.4%，抗凝治疗有效率为97.1%，一般处理无效。溶栓组并发出血者5例，抗凝组并发出血者4例。入选的5例维吾尔族病例药物治疗量相比汉族偏大，INR达标时间长。结论：对于年龄60岁、长期吸烟、心血管疾病、下肢静脉疾病、手术与肥胖患者，应视为急性肺栓塞的高危人群并定期筛查，及早预防栓塞的发生、发展。CTPA可作为确诊肺栓塞的首选检查手段，而D-dimer、血气分析、超声心动图（echocardiography，ECHO）等可作为辅助诊断手段。大面积急性肺栓塞患者治疗有效率低于非大面积及次大面积。溶栓和抗凝治疗是APE有效的治疗手段，可显著降低其死亡率。5例维吾尔族患者相比入选的汉族患者而言，药物的治疗量偏大，INR达标时间延长。种族因素可能对药物治疗剂量有影响，需进一步研究探讨。
[Abstract]:Objective: to analyze the clinical characteristics of acute pulmonary embolism (acute pulmonary) and to observe the clinical safety of thrombolysis and anticoagulant therapy in order to reduce the misdiagnosis rate and miss diagnosis rate and to give safe and effective treatment measures in time. Methods: the general data, hospitalization time, risk factors and clinical manifestations of 52 patients with acute pulmonary embolism admitted from January 2008 to February 2012 in the first affiliated Hospital of Medical College of Shihezi University of Xinjiang were retrospectively analyzed. The results of laboratory and imaging examination as well as the clinical data such as treatment methods and outcomes were analyzed. The frequency of occurrence of each clinical data was counted and the therapeutic effect and prognosis of different treatment methods were analyzed by statistical method. Results: 1. Elderly patients (60 years old), smoking, lower extremity venous disease, surgery, hypertension, coronary heart disease are common risk factors for pulmonary embolism, more than two risk factors in 40 cases. The most common symptom was dyspnea, followed by chest pain, hemoptysis and cough. Among them, 11 cases (21.2%) had hemoptysis. In addition, typical dyspnea, hemoptysis and chest pain were found in 5 cases (9.6%) of ape patients. Arterial blood gas analysis showed that 42 cases (93.3%) were hypoxemia (Pao _ 2 10.7 KPA / 80 mmHg) (i.e. oxygen partial pressure 80 mmHg). The results of immunoturbidimetry showed that 45 cases (95.7%) of D-dimer showed 0.5ugmml.5.The chest radiographs had 96% of secondary lung tissue changes. The typical SIQIII T _ (III) sign was 6.1, the positive rate of sinus tachycardia was 61.2, and T wave inversion of T wave in chest lead was 28.6B / BBIRB6.6. Echocardiography revealed pulmonary hypertension in 13 cases (31.0%), right ventricular wall motion loss in 12 cases (28.6%), tricuspid regurgitation in 15 cases (35.7%), right ventricular dilatation in 7 cases (16.7%), pericardial effusion in 1 case (2.4%). 12 cases of venous thrombosis were detected by Doppler angiography. 7. Ct pulmonary angiography (computed tomography pulmonary) revealed the defect of pulmonary artery and / or branches in 48 cases, including 47 cases of right inferior lobe, 40 cases of superior lobe, 29 cases of middle lobe, 38 cases of left lower lobe. Upper lobe 32 cases. The effective rate of thrombolytic therapy was 71.4 and the effective rate of anticoagulant therapy was 97.1.The general treatment was ineffective. Bleeding occurred in 5 cases in thrombolytic group and 4 cases in anticoagulant group. The dosage of drug therapy in 5 Uygur cases was longer than that in Han nationality. Conclusion: patients aged 60 years with chronic smoking, cardiovascular disease, venous disease of lower extremity, surgery and obesity should be regarded as high risk group of acute pulmonary embolism and be screened regularly to prevent embolism as early as possible. CTPA can be used as the first choice in the diagnosis of pulmonary embolism, and D-dimer, blood gas analysis, echocardiography and echo can be used as auxiliary diagnostic methods. The effective rate of large-area acute pulmonary embolism was lower than that of non-large and sub-large pulmonary embolism. Thrombolytic therapy and anticoagulant therapy are effective treatment methods for ape, which can significantly reduce the mortality rate of 5 cases of Uygur patients compared with the selected Han nationality patients, the amount of drug treatment is too large and the time of reaching the standard of INR is longer than that of the selected Han nationality patients. Racial factors may have an effect on the dosage of drug therapy and need further study.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563.5

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