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对2011年370名煤工尘肺患者以改良Wells评分法(2003)进行病例筛选;对其中Wells评分≥2分者进一步完善D-Dimer(ELISA法)、心电图(ECG)、肺动脉CT血管造影(CTPA)、超声心动图(UCG)及下肢静脉加压超声显像检查,明确是否存在肺血栓栓塞症和(或)深静脉血栓形成,并记录其临床特点。结果显示,370例煤工尘肺患者中改良Wells评分≥2分者共39例,明确合并静脉血栓栓塞症者34例,其中合并肺血栓栓塞症者25例,合并深静脉血栓形成9例,同时合并肺血栓栓塞症及深静脉血栓形成者6例。煤工尘肺合并肺血栓栓塞症者的临床表现以劳力性呼吸困难及气促、慢性咳嗽急性加重及胸痛最常见。煤工尘肺合并深静脉血栓形成者的临床表现以水肿、活动时胀痛、乏力最常见。提示煤工尘肺患者合并静脉血栓栓塞症后,临床表现改变可不明显。改良Wells评分法(2003)可作为疑似静脉血栓栓塞症的有效筛选手段。
A total of 370 coal worker pneumoconiosis patients were screened by modified Wells score method (2003) in 2011. D-Dimer (ELISA), electrocardiogram (ECG), pulmonary CT angiography (CTPA) ), Echocardiography (UCG) and venous pressure ultrasound examination of the lower extremity to determine whether there is pulmonary thromboembolism and / or deep venous thrombosis, and record the clinical features. The results showed that in 370 coal miners with pneumoconiosis, weighed Wells score≥2 points were 39 cases, 34 cases were complicated with venous thromboembolism, including 25 cases with pulmonary thromboembolism and 9 cases with deep venous thrombosis, Six patients with pulmonary thromboembolism and deep venous thrombosis. Coal workers pneumoconiosis with pulmonary thromboembolism who clinical manifestations of exertional dyspnea and shortness of breath, acute exacerbation of chronic cough and chest pain are the most common. Coal workers pneumoconiosis with deep venous thrombosis were clinical manifestations of edema, active pain, fatigue, the most common. Prompt coal workers pneumoconiosis patients with venous thromboembolism, the clinical manifestations may not change significantly. The modified Wells score (2003) can be used as an effective screening method for suspected venous thromboembolism.