310例肺栓塞临床预后和生存分析研究
发布时间：2018-10-29 19:38
【摘要】：目的探讨急性肺栓塞患者预后不良的影响因素以及影响生存时间的危险因素方法对2004年1月至2013年12月上海复旦大学附属中山医院,经CT肺动脉血管成像(computed tomography pulmonary angiography,CTPA)和(或)肺通气灌注扫描确诊的310例急性肺栓塞患者,进行临床资料的回顾性分析,对影响临床疗效的因素进行多元logistics回归分析;对上述患者出院后进行生存时间随访,行Cox比例风险回归分析。结果310例急性肺栓塞患者,男性165例(53.2%),女性145例(46.8%)。年龄18-86岁,平均年龄(63.28±15.30)岁。临床治疗有效285例,治疗无效25例。对急性肺栓塞患者的危险因素、临床表现、实验室检查等资料进行卡方检验,结果显示以下7个变量在肺栓塞的临床疗效中存在差异:恶性肿瘤、神志精神改变、白细胞增高(WBC109/l)、低氧血症(Pa O260 mm Hg)、低血压(收缩压90mm Hg)、肺栓塞分型、PESI评分(详见表3)。以上述变量为自变量,建立多元logistic回归分析显示:在其他条件恒定的情况下,肺栓塞分型中的大面积肺栓塞、低氧血症、白细胞增高和合并恶性肿瘤导致肺栓塞治疗无效的危险性增加依次为22.625倍、10.915倍、8.120倍和5.142倍(详见表4)。对上述310例肺栓塞患者出院后进行生存时间随访,共收集到81例门诊及电话随访结果,随访时间0.5-24个月,平均随访时间(22.59±19.27)个月,共有28例患者死亡,生存53例。建立Cox比例风险回归模型显示肺动脉收缩压增高(≥50mm Hg)发生死亡的危险度是未增高组(50mm Hg)的9.240倍(95%CI:2.307~37.013),提示肺动脉收缩压增高者(≥50mm Hg)在长期生存方面劣于肺动脉压未增高者;相同肺动脉收缩压水平下,合并恶性肿瘤发生死亡的危险度是非恶性肿瘤患者的3.7倍(95%CI:1.010~13.562)(详见表5)。结论大面积肺栓塞、低氧血症、白细胞增高、合并恶性肿瘤可能是肺栓塞预后不良的影响因素。肺动脉收缩压增高(≥50mm Hg)、合并恶性肿瘤对生存时间影响明显,且发生死亡的风险增大。
[Abstract]:Objective to investigate the risk factors of poor prognosis in patients with acute pulmonary embolism. Methods from January 2004 to December 2013, Zhongshan Hospital affiliated to Fudan University, Shanghai, underwent CT pulmonary artery angiography (computed tomography pulmonary angiography,). The clinical data of 310 patients with acute pulmonary embolism diagnosed by CTPA and / or pulmonary ventilation perfusion scanning were analyzed retrospectively and the factors affecting the clinical efficacy were analyzed by multivariate logistics regression analysis. The survival time was followed up after discharge and Cox proportional risk regression analysis was performed. Results among 310 patients with acute pulmonary embolism, 165 (53.2%) were male and 145 (46.8%) were female. The average age was (63.28 卤15.30) years. Clinical treatment was effective in 285 cases and ineffective in 25 cases. The data of risk factors, clinical manifestation, laboratory examination and so on in patients with acute pulmonary embolism were tested by chi-square test. The results showed that there were differences in the clinical efficacy of the following seven variables in the treatment of pulmonary embolism: malignant tumor, mental and mental changes, and so on. Leucocytosis (WBC109/l), hypoxemia (Pa O 260 mm Hg), hypotension (type of pulmonary embolism of systolic blood pressure 90mm Hg), PESI score) (see table 3 for more details). Using the above variables as independent variables, a multivariate logistic regression analysis was established. The results showed that large area pulmonary embolism and hypoxemia were found in the classification of pulmonary embolism under the condition of constant other conditions. The risk of pulmonary embolism was increased by 22.625 times, 10.915 times, 8.120 times and 5.142 times respectively due to leukocytosis and malignant tumor (see table 4 for details). The survival time of 310 patients with pulmonary embolism was followed-up after discharge. 81 patients were followed up by telephone and outpatient service. The follow-up time was 0.5-24 months (mean 22.59 卤19.27) months, and 28 patients died. 53 cases survived. Cox proportional risk regression model showed that the risk of death in patients with elevated pulmonary artery systolic blood pressure (鈮，
本文编号：2298615
[Abstract]:Objective to investigate the risk factors of poor prognosis in patients with acute pulmonary embolism. Methods from January 2004 to December 2013, Zhongshan Hospital affiliated to Fudan University, Shanghai, underwent CT pulmonary artery angiography (computed tomography pulmonary angiography,). The clinical data of 310 patients with acute pulmonary embolism diagnosed by CTPA and / or pulmonary ventilation perfusion scanning were analyzed retrospectively and the factors affecting the clinical efficacy were analyzed by multivariate logistics regression analysis. The survival time was followed up after discharge and Cox proportional risk regression analysis was performed. Results among 310 patients with acute pulmonary embolism, 165 (53.2%) were male and 145 (46.8%) were female. The average age was (63.28 卤15.30) years. Clinical treatment was effective in 285 cases and ineffective in 25 cases. The data of risk factors, clinical manifestation, laboratory examination and so on in patients with acute pulmonary embolism were tested by chi-square test. The results showed that there were differences in the clinical efficacy of the following seven variables in the treatment of pulmonary embolism: malignant tumor, mental and mental changes, and so on. Leucocytosis (WBC109/l), hypoxemia (Pa O 260 mm Hg), hypotension (type of pulmonary embolism of systolic blood pressure 90mm Hg), PESI score) (see table 3 for more details). Using the above variables as independent variables, a multivariate logistic regression analysis was established. The results showed that large area pulmonary embolism and hypoxemia were found in the classification of pulmonary embolism under the condition of constant other conditions. The risk of pulmonary embolism was increased by 22.625 times, 10.915 times, 8.120 times and 5.142 times respectively due to leukocytosis and malignant tumor (see table 4 for details). The survival time of 310 patients with pulmonary embolism was followed-up after discharge. 81 patients were followed up by telephone and outpatient service. The follow-up time was 0.5-24 months (mean 22.59 卤19.27) months, and 28 patients died. 53 cases survived. Cox proportional risk regression model showed that the risk of death in patients with elevated pulmonary artery systolic blood pressure (鈮，
本文编号：2298615
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