宁夏地区复发性肺血栓栓塞症影响因素分析

发布时间：2018-12-13 05:45

【摘要】：目的：复发性肺栓塞是肺血栓栓塞症最危险的不良预后事件之一，本研究通过分析影响PTE复发的相关危险因素，以降低复发率。资料与方法：收集2009年1月至2012年12月期间于宁夏医科大学总医院住院的肺血栓栓塞症患者的病历资料，比较复发性肺栓塞与非复发性肺栓塞患者的年龄、性别、民族、危险因素、症状、体征、相关实验室检查、治疗及预后的差别，并对可能影响PTE复发的相关因素进行分析。结果：宁夏医科大学总医院4年期间共有846例PTE住院病例，住院期间死亡病例有25例，最终共683例患者配合完成了随访工作，失访率16.8%。有52例证实为复发性肺栓塞，，非复发组病例为631例。两组之间性别、年龄及民族差异无统计学意义。两次PTE事件时间间隔为0.5个月~119个月，首次发生PTE后2年内最容易发生复发事件，此后则呈现逐年下降的趋势。复发性肺栓塞最常见的危险因素为合并慢性内科疾病（69.2%），其次为DVT/静脉炎（59.6%）与吸烟（26.9%）。应用单因素分析结果显示：合并慢性内科疾病、手术及外伤、DVT/静脉炎、特发性PTE、短程抗凝、INR未达标与PTE复发有关。进一步行非条件Logistic回归分析结果显示：慢性内科疾病、DVT/静脉炎、特发性PTE、短程抗凝治疗与PTE的复发具有显著相关性。呼吸困难/气短、心悸、紫绀、P2亢进及下肢水肿在复发性肺栓塞病例中更为常见。超声心动图结果显示：复发组平均肺动脉内径（27.33+4.90mm）、右心室前后径（43.91+9.27mm）及右室流出道（29.65+6.11mm）较非复发组明显增宽（P＜0.05）。本组有27例（51.9%）复发性PTE患者合并CTEPH，有10例（19.2%）复发性PTE患者于随访结束前死亡。结论：PTE在发病后2年内易发生复发事件；合并慢性内科疾病、DVT/静脉炎、特发性PTE、短程抗凝治疗是PTE复发的独立危险因素。复发性肺栓塞患者CTEPH发生率较高，预后较差，病死率高。
[Abstract]:Objective: recurrent pulmonary embolism is one of the most dangerous adverse prognostic events in pulmonary thromboembolism. Materials and methods: the medical records of patients with pulmonary thromboembolism were collected from January 2009 to December 2012 in the General Hospital of Ningxia Medical University, and the age, sex and nationality of patients with recurrent pulmonary embolism and non-recurrent pulmonary embolism were compared. Risk factors, symptoms, signs, laboratory tests, treatment, and prognosis were analyzed, and factors that might influence the recurrence of PTE were analyzed. Results: a total of 846 cases of PTE were hospitalized in the General Hospital of Ningxia Medical University in 4 years and 25 cases died in hospital. There were 52 cases of recurrent pulmonary embolism and 631 cases of non-recurrent pulmonary embolism. There was no significant difference in sex, age and nationality between the two groups. The interval between the two PTE events was 0.5 months to 119 months. Recurrence events were most likely to occur within 2 years after the first occurrence of PTE, and then decreased year by year. The most common risk factors for recurrent pulmonary embolism were chronic medical diseases (69.2%), DVT/ phlebitis (59.6%) and smoking (26.9%). Univariate analysis showed that the combination of chronic internal diseases, surgery and trauma, DVT/ phlebitis, short term anticoagulation of idiopathic PTE, and INR substandard were associated with the recurrence of PTE. Further non-conditional Logistic regression analysis showed that chronic internal diseases, DVT/ phlebitis, short term anticoagulant therapy of idiopathic PTE, were significantly correlated with the recurrence of PTE. Dyspnea / shortness of breath palpitation cyanosis hyperP2 and lower limb edema are more common in recurrent pulmonary embolism. The results of echocardiography showed that the mean pulmonary artery diameter (27.33 4.90mm), right ventricular anteroposterior diameter (43.91 9.27mm) and right ventricular outflow tract (29.65 6.11mm) in recurrent group were significantly wider than those in non-recurrent group (P < 0. 05). There were 27 cases (51.9%) of recurrent PTE patients with CTEPH, and 10 cases (19.2%) of recurrent PTE patients died before the end of follow-up. Conclusion: PTE is prone to relapse within 2 years after the onset of PTE, and chronic medical diseases, DVT/ phlebitis and short term anticoagulant therapy of idiopathic PTE, are independent risk factors for PTE recurrence. Recurrent pulmonary embolism patients with high incidence of CTEPH, poor prognosis, high mortality.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563.5

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