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目的探讨老年急性肺血栓栓塞患者远期预后及其危险因素。方法回顾性分析血栓肺栓塞(PE)的老年患者82例,根据随访结局分为预后良好组与预后不良组,分析影响老年远期预后的危险因素。结果 76例接受随访的老年PE患者中,预后良好患者49例,预后不良27例,其中死亡18例(23.68%),PE复发9例(11.84%);既往VET史、合并肿瘤、合并下肢静脉血栓(DVT)、右心功能不全、治疗前氧分压(PaO_2)<60 mm Hg、治疗后栓塞面积>30%、治疗前肺动脉收缩压(SPAP)>50 mm Hg、治疗后SPAP>40 mm Hg在预后良好组和预后不良组之间有统计学差异(P<0.05)。多变量Logistic回顾分析发现,既往VET(OR=1.348)、右心功能不全(OR=2.425)、合并肿瘤(OR=3.898)、治疗后SPAP>40 mm Hg(OR=1.613),治疗后栓塞面积>30%(OR=1.824)是影响远期预后的危险因素。结论既往VET、右心功能不全、合并肿瘤、治疗后SPAP>40 mmHg及治疗后栓塞面积>30%为影响远期预后的独立危险因素。
Objective To investigate the long-term prognosis and risk factors of elderly patients with acute pulmonary thromboembolism. Methods Eighty-two elderly patients with thromboembolism (PE) were retrospectively analyzed. According to the outcome of follow-up, the patients were divided into two groups: the good prognosis group and the poor prognosis group, and the risk factors influencing the long-term prognosis of the elderly were analyzed. Results Of the 76 elderly patients with PE who were followed up, 49 patients with good prognosis and 27 patients with poor prognosis included 18 deaths (23.68%) and 9 PE (11.84%) PE recurrences. Previous VET history, combined tumor, Thrombus (DVT), right ventricular dysfunction, PaO_2 <60 mm Hg before treatment, embolization area> 30% after treatment, pulmonary arterial systolic pressure (SPAP)> 50 mm Hg before treatment, There was a significant difference in Hg between the good prognosis group and the poor prognosis group (P <0.05). Multivariate logistic regression analysis showed that the VET (OR = 1.348), right ventricular dysfunction (OR = 2.425), combined tumor (OR = 3.898) and SPAP> 40 mm Hg after treatment > 30% (OR = 1.824) is a risk factor affecting long-term prognosis. CONCLUSIONS: Previous VET, right ventricular dysfunction, combined tumor, post-treatment SPAP> 40 mmHg and post-treatment embolization area> 30% were independent risk factors for long-term prognosis.