摘要
目的总结肺动脉栓塞诊治中的经验、教训,以提高对肺栓塞的认识。方法对27例肺栓塞患者的一般资料、临床表现、实验室检查、心电图、影像学检查,误诊情况与治疗进行回顾性分析。结果27例中≥60岁者15例,平均年龄68·3岁。81·5%(22/27)有下肢静脉血栓。临床症状:81·5%(22/27)有呼吸困难,胸痛只有8例,咯血只有9例,晕厥只有3例。动脉血气分析:PaO2降低25例,ALT升高19例。心电图只有13例呈SⅠQⅢTⅢ变化。X胸片有5例正常。19例行放射性核素肺灌注显像,其中呈双肺多处血流灌注缺损18例。27例中曾被误诊22例。经溶栓或其他治疗,死亡8例。结论肺动脉栓塞最常见的危险因素是下肢深静脉血栓形成,典型“三联症”很少见,临床误诊率很高,放射性核素肺灌注显像是诊断肺栓塞的安全可靠方法,抗凝治疗效果优于单纯对症治疗。
Objective To Summarize the experience in the diagnosis and therapy for embolism in pulmonary artery so as to strengthen the recognition to them. Methods Retrospective analyses were performed in 27 cases on the aspects of general materials, clinical manifestation, laboratory test, electrocardiogram, imaging examination, misdiagnosis and therapy. The average age was 68.3 years old. There were 15 patients older than or equal to 60 years old. Results There were 22 cases suffered from thrombosis in lower limb＇s veins. Dyspnea as clinical symptoms was found in 22 cases （ 81.5% ）. There were only nine, eight and three cases respectively manifesting hemoptysis, thoracalgia and faint. There were 25 cases whose PaO2 descended, and 19 cases whose ALT ascended, and 13 cases whose electrocardiograms changed in S （Ⅰ）, Q （Ⅲ ） and T （Ⅲ） waves. Among the 19 cases thai were examined with radionuclidic imaging, there were 18 cases whose bilateral lungs showed infusion defection of blood flow on many spots. Out of 27 cases, 22 had experienced misdiagnosis. Eight cases resulted in death after thrombolytic therapy. Conclusion The most dangerous factor of pulmonary arterial embolism is thromboses in the lower limb＇s veins. Typical trilogy is seldom found, and the misdiagnosis rate is high. Pulmonary radionuclidic infusion imaging is a safe and reliable way to the diagnosis of embolism in the lungs. Anticoagulant therapy should be administered, which looks better than simple allopathy.
出处
《临床军医杂志》
CAS
2005年第4期423-425,共3页
Clinical Journal of Medical Officers
关键词
肺动脉栓塞
临床分析
pulmonary arterial embolism
clinical analysis
