恶性肿瘤合并肺栓塞62例临床分析
[Abstract]:[Background] Thrombosis is a common complication of cancer, although there is a difference in the genetic risk factors of thrombosis of different races, the main acquired risk factors related to thrombosis in Asian are similar. In the Asian population, some patients with malignant tumor are the most common complications of venous thromboembolism. Pulmonary embolism (PE) is one of the most common complications of pulmonary embolism. Pulmonary embolism (PE) is one of the most common complications. Pulmonary embolism (PE) is one of the most common complications. Pulmonary embolism (PE) is one of the most common complications, and pulmonary embolism (PE) is one of the most common complications, but pulmonary embolism (PE) is one of the most common complications, but pulmonary embolism (PE) is one of the most common complications, but pulmonary embolism (PE) is a common complication, but pulmonary embolism (PE) is a common complication, but pulmonary embolism (PE) is very common, but mortality is still high.[Objective] The clinical manifestations of malignant tumor complicated with pulmonary embolism are hidden, easily misdiagnosed and missed, which is not conducive to early diagnosis and treatment. The risk factors of pulmonary embolism, risk stratification of pulmonary embolism, clinical manifestation, anti-coagulation effect and so on are analyzed, and more references and theoretical bases are provided for clinical diagnosis and treatment.[Methods] 62 patients with malignant tumor complicated with pulmonary embolism treated at the First Affiliated Hospital of Zhengzhou University from January 1, 2015 to December 31, 2016 were treated as malignant tumor complicated pulmonary embolism group, and 62 patients with simple pulmonary embolism were randomly selected as the group of simple pulmonary embolism. The clinical data of all the patients enrolled were recorded. The statistical software SPSS17. 0 was used to analyze the clinical data of the three groups.[Results] (1) The risk factors of malignant tumor complicated with pulmonary embolism were compared with the risk factors of simple malignant tumor group. In the two groups, the P value in smoking, near-term operation (week 4), previous VTE history, central venous tube operation (week 1), hypoproteinemia, combined cerebral infarction, combined slow-resistance lung, advanced tumor, tumor type (adenocarcinoma) were 0. 05, and the difference was statistically significant. Among them, 10 (16.1%) were smoked, 30 (48. 4%) were in recent operation (48. 4%), 8 cases of PTE occurred in peri-operative period. Among them, 1 occurred during the operation (mean post-operative 4. 5 days), 8 cases were combined with cerebral infarction, 11 cases were combined with slow-resistance lung, 8 cases of previous VTE history and 8 cases of hypoproteinemia. (2) Compared with the risk stratification of pulmonary embolism in pulmonary embolism group and pulmonary embolism group, the P value of two groups in high-risk and low-risk pulmonary embolism stratification was 0. 05, and the difference was statistically significant. Among the two groups, 9 cases (17%) and 2 (4%) were high-risk pulmonary embolism, 0 (0%) and 6 (12%) respectively. (3) In the malignant tumor complicated pulmonary embolism group, the primary malignant tumor was 32.3% in the digestive system, 25.8% in the respiratory system, 14.5% in the respiratory system, 4.8% in the system and 4.8% in the urinary system. Among them, the primary tumor was in the lung (25.8%), the large intestine (12. 9%), the liver (8. 1%), the esophagus (6. 5%), the breast (6. 5%), in the parotid gland (3. 2%), the thyroid gland (3. 2%), the stomach (3. 2%), the small intestine (1.6%). Among the 16 cases of lung cancer, 11 cases (17. 7%), squamous cell carcinoma (6. 5%), small cell carcinoma (1. 6%), malignant tumor complicated with pulmonary embolism group, advanced malignant tumor 35 cases (56. 5%), lung cancer in 13 cases (20.9%), advanced lung cancer in 10 cases (16.1%). (4) By comparing the clinical symptoms, signs, partial laboratory data and auxiliary examination results of patients with malignant tumor complicated with pulmonary embolism and simple pulmonary embolism, the difference was statistically significant between the two groups in chest distress, dyspnea, lower extremity edema, chest pain, fever, varicose veins of lower limbs, purple color, up tone, platelet, D-dimer level and pulmonary hypertension. (5) There was a statistically significant difference between the two groups: 32 cases (80. 0%) and 53 cases (96.4%), respectively.[Conclusion] 1. In the presence of smoking, recent surgical history (at least 4 weeks), central venous tube operation (at least 1 week), previous VTE history, hypoproteinemia, combined cerebral infarction, combined slow resistance lung, advanced stage of tumor, adenocarcinoma and other factors, the risk of pulmonary embolism in malignant tumor increased. 3. The malignant tumor complicated with pulmonary embolism was seen in the digestive system and respiratory system primary tumor, and lung adenocarcinoma was seen in the respiratory system. 4. The clinical manifestations of malignant tumor complicated with pulmonary embolism were hidden, and when the malignant tumor patient had chest distress, dyspnea, lower limb edema, chest pain, fever, varicose veins of lower limbs, purple color, up tone and other clinical manifestations and platelet, D-dimer level, the pulmonary artery hypertension level increased, it was impossible to explain its cause with the existing disease, and the possibility of pulmonary embolism should be considered. 5. The anti-coagulation effect of malignant tumor combined with pulmonary embolism was inferior to the anticoagulant effect of pulmonary embolism alone.
【学位授予单位】:郑州大学
【学位级别】:硕士
【学位授予年份】:2017
【分类号】:R563.5;R73
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