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目的分析急性肺动脉血栓栓塞症(PTE)的临床特征以及溶栓、抗凝治疗的疗效,以期降低其漏诊率和误诊率,提高存活率。方法回顾性分析2002年1月至2006年12月沈阳军区总医院呼吸内科住院的122例急性PTE患者的危险因素、临床表现、辅助检查及治疗方案等临床资料。结果急性PTE的危险因素有高龄、高血压等心脏基础疾病以及近期手术、糖尿病、骨折、长期卧床等。临床症状以呼吸困难最为常见,出现“三联征”症状(呼吸困难、胸痛、咯血)的为数极少。D-二聚体对急性PTE具有高度敏感性,结合心脏超声、CT肺动脉造影(CTPA)、肺通气/灌注扫描等检查结果可明确诊断。积极予以溶栓、抗凝治疗可降低病死率。结论急性PTE临床症状多种多样,临床医生应高度警惕。D-二聚体可作为急性PTE筛选检查。确诊后进行规范化治疗可显著改善预后。
Objective To analyze the clinical characteristics of acute pulmonary thromboembolism (PTE) and the curative effect of thrombolysis and anticoagulation therapy in order to reduce its misdiagnosis rate and misdiagnosis rate and improve the survival rate. Methods The clinical data of 122 acute PTE patients hospitalized in Department of Respiratory Medicine of Shenyang Military Region General Hospital from January 2002 to December 2006 were retrospectively analyzed. Clinical data, clinical manifestations, laboratory examinations and treatment regimens were retrospectively analyzed. Results The risk factors of acute PTE are heart-based diseases such as advanced age and hypertension, as well as recent surgery, diabetes, fractures and bed rest. Clinical symptoms are most common with dyspnea, with very few “Syndromes” (dyspnea, chest pain, hemoptysis). D-dimer is highly sensitive to acute PTE and can be clearly diagnosed in combination with cardiac ultrasound, CT pulmonary angiography (CTPA), pulmonary ventilation / perfusion scan and other tests. Active thrombolysis, anticoagulant therapy can reduce mortality. Conclusion There are many clinical symptoms of acute PTE. Clinicians should be highly vigilant. D-dimer can be used as an acute PTE screening test. After the diagnosis of standardized treatment can significantly improve the prognosis.