肺血栓栓塞症尸检资料47例分析

发布时间：2018-09-15 05:42

【摘要】：目的:肺血栓栓塞症(pulmonary thromboembolism,PTE)为一种潜在的致命性疾病,许多患者至死后尸检才得以明确诊断。本文通过了解PTE尸检临床及病理特点,以提高对PTE的认识。方法:采用回顾性研究方法,收集47例PTE病例的一般情况、基础疾病及诱因、临床表现、临床诊治、尸检血栓部位,总结分析临床及病理特点。结果:1)12年间共完成尸检784例,其中PTE 47例(2例合并脂肪栓塞),发生率6.0%。47例尸检PTE中有46例为致死性肺栓塞(fatal pulmonary embolism,FPE)(97.9%);2)分析47例PTE尸检资料发现,每例均至少存在一项危险因素,43例(91.5%)存在2项及以上危险因素,其中最常见危险因素为创伤骨折(26例,55.3%)及手术(25例,53.2%)。临床症状以呼吸困难(19例,40.4%)、心搏骤停(15例,31.9%)及晕厥(13例,27.7%)常见。24例(51.1%)合并下肢深静脉血栓形成(deep vein thrombosis,DVT),10例(21.3%)合并右心血栓,1例(2.1%)合并基底动脉血栓。栓塞部位以肺动脉主干多见(28例,59.6%),其中骑跨型肺栓塞20例(42.6%)。47例患者中22例(46.8%)死前疑诊为PTE,但均未行抗凝或溶栓治疗,仅1例予低分子肝素预防血栓形成。结论:PTE容易继发于有高危因素的患者,尤其是创伤骨折及手术。其临床症状无特异性,缺乏典型三联征,误诊率、漏诊率及致死率极高,临床工作者对PTE诊治意识不足。
[Abstract]:Objective: pulmonary thromboembolism (pulmonary thromboembolism,PTE) is a potentially fatal disease. The clinical and pathological features of PTE autopsy were studied in order to improve the understanding of PTE. Methods: a retrospective study was carried out in 47 cases of PTE. The clinical manifestations, clinical diagnosis and treatment, and the location of thrombus in autopsy were collected, and the clinical and pathological features were summarized and analyzed. Results A total of 784 autopsy cases were completed in 12 years, of which 47 cases were PTE (2 cases with fat embolism), 46 cases of PTE were fatal pulmonary embolism (fatal pulmonary embolism,FPE) (97.9%) in 6.0.47 cases of PTE. There were at least one risk factor in 43 cases (91.5%). The most common risk factors were traumatic fracture (26 cases, 55.3%) and surgery (25 cases, 53.2%). The clinical symptoms were dyspnea (19 cases, 40.4%), cardiac arrest (15 cases, 31.9%) and syncope (13 cases, 27.7%). 24 cases (51.1%) were complicated with (deep vein thrombosis,DVT), 10 cases (21.3%) with right cardiac thrombosis and 1 case (2.1%) with right cardiac thrombosis and basilar artery thrombosis. Pulmonary artery trunk was the most common site of embolism (28 cases, 59.6%). Among them, 20 cases (42.6%) had straddle pulmonary embolism. 22 cases (46.8%) had suspected PTE, before death, but none of them were treated with anticoagulant or thrombolytic therapy, only 1 case was treated with low molecular weight heparin to prevent thrombosis. Conclusion: Pte may be secondary to patients with high risk factors, especially trauma fracture and surgery. Its clinical symptoms are nonspecific, lack of typical triple sign, misdiagnosis rate, missed diagnosis rate and fatality rate are very high, clinical workers have insufficient consciousness of diagnosis and treatment of PTE.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.5

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