急性肺栓塞39例临床特征分析
Clinical Characteristics of Acute Pulmonary Embolism: An Analysis of 39 Cases

目的：回顾性分析39例肺栓塞患者的临床特征，为急性肺栓塞的有效预防、诊断和治疗提供参考依据。方法：选取2019年1月~2019年12月于酒钢医院住院确诊的39例急性肺栓塞患者，回顾性分析其年龄、性别特点、伴随疾病、危险因素、临床表现、影像学特征、心电图特征、心脏彩超表现、肺动脉CTA表现、D二聚体结果、危险分层及治疗措施。结果：高龄为肺栓塞独立危险因素。获得性危险因素有下肢静脉血栓、骨科手术、动脉粥样硬化、慢阻肺急性加重、心功能不全、高血压病、卒中、糖尿病、恶性肿瘤等。肺栓塞患者D二聚体增高者占93%，心电图有特征性表现者占84%，心脏彩超有特征性表现者占92%。结论：肺栓塞临床表现各异，猝死风险高，实验室检查又缺乏特异性，容易漏诊、误诊。目前肺动脉CT造影(CTPA)及肺动脉CTA仍是确诊肺栓塞的金标准，但对高危患者尤其是猝死患者，临床上不容许进行上述检查，应快速行床旁心电图机心脏彩超检查，同时行心肌损伤标志物、血气分析及D二聚体检查，快速做出临床诊断，快速启动溶栓、抗凝治疗及相关急救治疗措施。
Objective: To retrospectively analyze the clinical characteristics of 39 patients with acute pulmonary embolism and to provide reference for the effective prevention, diagnosis and treatment of acute pulmonary embolism. Methods: 39 cases with acute pulmonary embolism who were admitted to Jiugang Hospital from January 2019 to December 2019 were enrolled in this study. Their clinical data including age, sex, main characteristics, comorbidities, risk factors, clinical manifestations, imaging features, electrocardiogram, heart Doppler ultrasound, pulmonary artery CTA, D dimer, risk stratification and treatment measures were collected and retrospectively analyzed. Results: Old age was an independent risk factor for pulmonary embolism. Acquired risk factors include lower limb venous thrombosis, orthopedic surgery, atherosclerosis, acute exacerbation of COPD, cardiac insufficiency, hypertension, apoplexy, diabetes, and malignant tumors. In patients with pulmonary embolism, D-dimer elevation was found in 93% of patients, ECG characteristic expression was found in 84% of patients, and heart Doppler ultrasound characteristic expression was found in 92% of patients. Conclusion: The clinical manifestations of pulmonary embolism are different, the risk of sudden death is high, and the laboratory examination is lack of specificity, so it is easy to be misdiagnosed. The pulmonary CT angiography (CTPA) and pulmonary artery CTA are still the gold standard for the diagnosis of pulmonary embolism. However, for high-risk patients, especially those with sudden death, the above examinations are not allowed in clinical practice, and should be performed quickly by bedside ELECTRO cardiogram cardiac color Doppler examination, as well as myocardial injury markers, blood gas analysis and D-dimer examination, so as to make a rapid clinical diagnosis, and quickly start thrombolytic, anticoagulant therapy and related emergency treatment measures.