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目的探讨急诊就诊的肺栓塞病人的临床特征、诊断及治疗方法,从而提高急诊肺栓塞的诊治率。方法通过回顾性分析50例急诊诊断肺栓塞患者的临床表现、化验检查及溶栓、抗凝治疗的疗效。结果本组病人中最主要的临床表现为不同程度的呼吸困难(占60%)其次为胸痛(占36%),并出现不同程度的低氧血症(占70%)。DIC初筛中D二聚体较正常对照升高为64%,肺部CT和肺通气血流扫描的阳性率分别为97%和61.5%,溶栓+抗凝组的治愈率为86.7%(13/15)和抗凝组的治愈率为61.5%(16/25)。结论急诊就诊的肺栓塞病人其临床症状复杂,不典型,不同程度的呼吸困难伴有低氧血症是其主要的临床表现。血气分析和DIC检查可作为筛查肺栓塞的检查,肺部增强CT是急诊诊断肺栓塞有效而快捷的手段。应早期对病人进行干预,溶栓治疗相对于抗凝治疗更有效。
Objective To investigate the clinical features, diagnosis and treatment of patients with pulmonary embolism in emergency department to improve the diagnosis and treatment rate of emergency pulmonary embolism. Methods Retrospective analysis of 50 cases of emergency diagnosis of pulmonary embolism in patients with clinical manifestations, laboratory tests and thrombolysis, anticoagulant therapy. Results The main clinical manifestations in this group were dyspnea (60%), chest pain (36%), and hypoxemia (70%) in varying degrees. The D-dimer levels in primary DIC were 64% higher than those in normal controls, and the positive rates of CT and pulmonary ventilation were 97% and 61.5%, respectively. The cure rate of thrombolysis and anticoagulation was 86.7% 13/15) and the anticoagulant group was 61.5% (16/25). Conclusions The clinical symptoms of patients with pulmonary embolism in emergency department are complex and atypical. The different degree of dyspnea associated with hypoxemia is the main clinical manifestation. Blood gas analysis and DIC examination can be used as a screening test for pulmonary embolism, pulmonary enhanced CT is an effective and quick means of emergency diagnosis of pulmonary embolism. Patients should be treated early, thrombolytic therapy is more effective than anticoagulant therapy.