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目的提高对肺栓塞的认识,减少误诊。方法回顾性分析中国医科大学附属第一医院1995-01~2005-04收治的86例肺栓塞的临床资料。其中急性肺栓塞58例,慢性28例,并将其进行了对比分析。结果在年龄分布上慢性肺栓塞随年龄增长有增高的趋势。二者的基础疾病均以下肢深静脉血栓为主。劳力性呼吸困难、胸闷、心悸在慢性者更多见。肺动脉第Ⅱ心音亢进、颈静脉怒张、双下肢水肿等体征在慢性病人更加明显。动脉血氧分压降低及肺泡-动脉氧分压差的增大慢性者更加显著。60%的慢性病人有明显的右心扩大。所有慢性肺栓塞病人均有肺的多段灌注缺损。急性者84%经溶栓或抗凝治疗后症状改善,慢性者57%有效。慢性者5例(18%,5/28)在近期内死亡,高于急性者3例(5%,5/58)。结论慢性肺栓塞临床过程较急性肺栓塞更缺乏特异性,往往以慢性肺动脉高压和右心负荷过重的形式出现,更易误诊,且病死率高,对此临床医生更应给予足够的重视。
Objective To raise awareness of pulmonary embolism and reduce misdiagnosis. Methods The clinical data of 86 patients with pulmonary embolism admitted from January 1995 to April 2005 in the First Affiliated Hospital of China Medical University were retrospectively analyzed. Among them, 58 cases of acute pulmonary embolism, chronic 28 cases, and its comparative analysis. Results The age distribution of chronic pulmonary embolism increased with age. Both the underlying diseases are mainly lower extremity deep vein thrombosis. Labor difficulty breathing, chest tightness, heart palpitations more common in chronic. Pulmonary heart sound hyperthyroidism, jugular vein engorgement, lower extremity edema and other signs in chronic patients is more obvious. Arterial partial pressure of oxygen and alveolar - arterial oxygen partial pressure increased chronic more significant. 60% of chronic patients have a clear right heart enlargement. All patients with chronic pulmonary embolism have multiple pulmonary perfusion defects. In 84% of acute cases, the symptoms improved after thrombolysis or anticoagulation, and in 57% of those with chronic symptoms. Chronic 5 patients (18%, 5/28) died in the near future, higher than those in 3 acute cases (5%, 5/58). Conclusion The clinical course of chronic pulmonary embolism is more specific than acute pulmonary embolism. It often appears in the form of chronic pulmonary hypertension and right heart overload. It is more easily misdiagnosed and has a higher case fatality rate. Clinicians should pay more attention to this.