本文選題：肺栓塞　切入點(diǎn)：肺血栓栓塞　出處：《河北醫(yī)科大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:再栓塞是肺血栓栓塞患者主要不良預(yù)后事件之一，關(guān)于再栓塞率及相關(guān)危險(xiǎn)因素目前尚無統(tǒng)一結(jié)論，本研究通過長期追蹤觀察臨床確診的肺栓塞患者，旨在了解再栓塞發(fā)生情況及相關(guān)危險(xiǎn)因素。 方法:收集1998年1月至2011年6月在河北醫(yī)科大學(xué)第二醫(yī)院住院期間經(jīng)螺旋CT肺血管成像(CTPA)或肺通氣灌注掃描確診的肺血栓栓塞患者的病例資料，并進(jìn)行平均28個(gè)月（確診之日至161個(gè)月）的隨訪調(diào)查，分析再栓塞發(fā)生情況。應(yīng)用單因素分析（t檢驗(yàn)或χ2檢驗(yàn)）時(shí)選擇P＜0.10的變量進(jìn)入回歸模型進(jìn)一步分析，對(duì)可能有意義的因素行多因素非條件logistic回歸分析，尋找再栓塞危險(xiǎn)因素。 結(jié)果:在161個(gè)月內(nèi)接受隨訪的385例肺栓塞患者中48例發(fā)生再栓塞，，再栓塞發(fā)生的時(shí)間構(gòu)成比依次為：第1年50.0%（24例），第2年22.92%（11例），第3年10.42%（5例），第4年5.41%（2例），第5年5.41%（2例），第6年5.41%（2例），第7年2.70%（1例），第8年2.70%（1例）。單因素分析（P＜0.10）顯示： D-dimer持續(xù)陽性、右心功能不全、特發(fā)性PTE、短療程抗凝治療（＜3月）、年齡＞65歲、吸煙、高血壓、下肢深靜脈血栓、低氧血癥等與再栓塞具有相關(guān)性（P＜0.05）；而多因素非條件logistic回歸分析發(fā)現(xiàn)僅D-dimer持續(xù)陽性（OR=28.257）、右心功能不全（OR=14.806）、特發(fā)性PTE（OR=7.839）、短療程抗凝治療（＜3月，OR=5.464）、年齡＞65歲（OR=9.518）、吸煙（OR=5.464）是發(fā)生再栓塞的獨(dú)立危險(xiǎn)因素（P＜0.05）；并且存在兩個(gè)以上因素者再栓塞率明顯增高，是單因素者的近3倍（87.50%vs21.66%，P=0.000）。 結(jié)論:肺栓塞患者在發(fā)病1年內(nèi)再栓塞風(fēng)險(xiǎn)最高，以后隨著時(shí)間的推移再栓塞發(fā)生率逐年下降，并且在所有肺栓塞的危險(xiǎn)因素中，D-dimer持續(xù)陽性、右心功能不全、特發(fā)性PTE、短療程抗凝治療（＜3月）、年齡＞65歲、吸煙是發(fā)生再栓塞的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective: re embolism is one of the main adverse prognostic events in patients with pulmonary thromboembolism. There is no unified conclusion on the rate of re embolism and related risk factors. To understand the occurrence of re-embolism and related risk factors. Methods: the data of patients with pulmonary thromboembolism diagnosed by spiral CT pulmonary angiography (CTPA) or pulmonary ventilation perfusion scan during hospitalization in the second Hospital of Hebei Medical University from January 1998 to June 2011 were collected. An average of 28 months (from the date of diagnosis to 161 months) was followed up to analyze the occurrence of re embolism. The variables P < 0. 10 were selected to enter the regression model for further analysis by using single factor analysis or 蠂 2 test. Multivariate non-conditional logistic regression analysis was performed to find the risk factors for re-embolization. Results: 48 of 385 patients with pulmonary embolism were followed up within 161 months. The time composition ratio of reembolism occurred in the following order: 50.024 cases in the first year, 22.92 cases in the second year, 10.42 cases in the third year, 5.41 cases in the fourth year, 2 cases in the fifth year, 2 cases in the sixth year, 2.70 cases in the 7th year, and 2.70% in the 8th year (P < 0.10). D-dimer continues to be positive, Right ventricular insufficiency, idiopathic PTEs, short course of anticoagulant therapy (< March, age > 65, smoking, hypertension, deep venous thrombosis of lower extremity). The multivariate conditional logistic regression analysis showed that only D-dimer continued positive ORT 28.257, right ventricular insufficiency 14.806, idiopathic PTER 7.8399A, short course anticoagulant therapy (< March OR5.464, age > 65 years, OR9.518, smoking OR5.464). The independent risk factor was P < 0.05, and the re-embolization rate was significantly higher in the patients with more than two factors. Nearly 3 times as much as that of single factor, 87.50% vs 21.66. Conclusion: the risk of re embolization in patients with pulmonary embolism is the highest within 1 year, and the incidence of re embolization decreases year by year with the passage of time, and D-dimer remains positive in all the risk factors of pulmonary embolism, right ventricular insufficiency. Idiopathic PTEs, short course anticoagulant therapy (< March, age > 65), smoking was an independent risk factor for re-embolism.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R563.5

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