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目的 分析急性肺栓塞的临床特点 ,有关实验室检查及观察溶栓抗凝治疗的临床效果。方法 对 2 1例肺栓塞患者经放射性核素肺灌注通气检查 ,或超声心电图确诊 ;17例经尿激酶 +肝素溶栓抗凝治疗 ,2 4小时后复查肺灌注通气扫描评价治疗效果。结果 男性以青壮年多见 ,女性患者以更年期以后发病明显增高 ,院外误诊率高达 76 %。临床上以呼吸困难最为多见 ,其次为胸痛。无创实验室检查中以放射性核素肺灌注通气检查阳性率最高 ,心电图出现SⅠQⅢTⅢ ,V1～V5T波倒置较多见 ,血气分析检查示低氧血症无二氧化碳潴留。 17例尿激酶溶栓治疗后 ,14例缺损肺段减少 >30 % ,有效率 82 .4%。结论 应提高对急性肺栓塞的警惕性 ,以减少误诊率 ,经确诊者须尽快行溶栓治疗。
Objective To analyze the clinical characteristics of acute pulmonary embolism, the clinical laboratory tests and observation of thrombolytic anticoagulant therapy. Methods Twenty-one patients with pulmonary embolism were diagnosed by radionuclide pulmonary perfusion ventilation or echocardiography. Seventeen patients were treated with urokinase and heparin thrombolysis anticoagulation. The pulmonary perfusion ventilation scans were performed after 24 hours to evaluate the therapeutic effect. Results Male to young and common more common, women patients with menopausal onset was significantly increased, misdiagnosis rate as high as 76%. Clinically, the most common breathing difficulties, followed by chest pain. In noninvasive laboratory tests, the positive rate of radionuclide pulmonary perfusion ventilation examination was the highest. ECG appeared SⅠQⅢTⅢ, V1 ~ V5T wave inversion was more common, blood gas analysis showed no hypoxemia without carbon dioxide retention. 17 cases of urokinase thrombolytic therapy, 14 cases of reduced lung segment reduction> 30%, the effective rate of 82.4%. Conclusion The vigilance of acute pulmonary embolism should be increased to reduce the misdiagnosis rate. Patients who have been diagnosed should be treated with thrombolytic therapy as soon as possible.