本文選題：肺栓塞　切入點(diǎn)：臨床特征　出處：《石河子大學(xué)》2017年碩士論文

【摘要】：目的本研究討論常見與少見的肺栓塞臨床特征;討論對(duì)診斷肺栓塞最有意義的臨床特征。方法連續(xù)入選2013年1月-2015年7月,疑似肺栓塞并在我院行CT肺血管造影(CTPA)318例,根據(jù)肺動(dòng)脈血管造影診斷分為肺栓塞組(PTE組)及非肺動(dòng)脈栓塞組(非PTE組),其中肺栓塞組患者155例,非肺栓塞組患者163例,并記錄兩組臨床癥狀、體征、危險(xiǎn)因素、實(shí)驗(yàn)室檢查、超聲心動(dòng)圖及心電圖結(jié)果。統(tǒng)計(jì)分析:采用spss17.0軟件包進(jìn)行統(tǒng)計(jì)分析。正態(tài)分布計(jì)量資料用均數(shù)±標(biāo)準(zhǔn)差表示;計(jì)量資料用頻數(shù)(率)表示,組間比較用卡方檢驗(yàn),多因素比較使用二分類Logistic回歸,以P0.05位差異有統(tǒng)計(jì)學(xué)意義。結(jié)果155例肺栓塞患者平均年齡(65.84±15.99)歲,常見臨床特征為呼吸困難、咳嗽、胸痛,分別占62.58%、60.65%、34.19%。常見體征為呼吸急促、心率加快、發(fā)熱、下肢不對(duì)稱性水腫、紫紺,分別占52.25%、29.03%、28.38%、27.74%、21.29%。D-二聚體500μg/L131例(84.51%)。血?dú)夥治?氧分壓80mm Hg 127例(81.94%),二氧化碳分壓35mm Hg 47例(30.32%),PH7.45者57例(36.7%)。血常規(guī):白細(xì)胞10×109/L 44例(28.39%),血小板300×109/L 24例(15.48%)。心電圖及超聲心動(dòng)圖異常包括胸導(dǎo)聯(lián)T波倒置、S1QIIITIII、右束支傳導(dǎo)阻滯、電軸右偏分別占21.05%、12.50%、9.21%和7.89%,右室擴(kuò)大及肺動(dòng)脈高壓,分別占14.94%和25.32%。常見危險(xiǎn)因素為制動(dòng)、外傷、手術(shù)、深靜脈血栓栓塞史分別占34.84%、15.48%、12.90%和7.09%。兩組比較:PTE組呼吸困難、呼吸加快、發(fā)紺、D-二聚體、氧分壓、二氧化碳分壓、S1QIIITIII、制動(dòng)、深靜脈血栓栓塞史均高于非PE組(P0.05)。二分類Logistic回歸分析:呼吸困難及白細(xì)胞10×109/L為危險(xiǎn)因素;腫瘤、血小板300×109/L為保護(hù)因素。結(jié)論肺栓塞缺乏臨床特異性表現(xiàn),白細(xì)胞計(jì)數(shù)可為肺栓塞危險(xiǎn)分層提供依據(jù),呼吸困難肺栓塞有較高的診斷價(jià)值,當(dāng)患者血?dú)夥治龀霈F(xiàn)低氧血癥同時(shí)伴有低碳酸血癥及PH輕度升高時(shí),應(yīng)警惕肺栓塞的可能。
[Abstract]:The purpose of this study is to discuss the common and uncommon clinical features of pulmonary embolism; discuss the clinical features of the most meaningful for the diagnosis of pulmonary embolism. Methods selected for the January 2013 -2015 year in July, and suspected pulmonary embolism in our hospital CT pulmonary angiography (CTPA) in 318 cases, according to pulmonary artery angiography diagnosis for pulmonary embolism group (PTE group) and non pulmonary embolism group (non PTE group), including 155 cases of pulmonary embolism patients, 163 cases of non pulmonary embolism patients, and record the clinical symptoms, two groups of symptoms, risk factors, laboratory examination, echocardiography and ECG results. Statistical analysis: Statistical analysis was performed using SPSS17.0 software package. The normal distribution of measurement data with standard deviation; frequency measurement data (rate), comparison between groups using chi square test, multiple comparisons using two classification Logistic regression with P0.05 difference was statistically significant. Results 155 cases of patients with pulmonary embolism average Age (65.84 + 15.99) years old, common clinical features were dyspnea, cough, chest pain, accounted for 62.58%, 60.65%, 34.19%. common signs for the shortness of breath, heart rate, fever, limb asymmetry edema, cyanosis, respectively 52.25%, 29.03%, 28.38%, 27.74%, two 21.29%.D- dimer of 500 g/L131 cases (84.51%). Blood gas analysis: oxygen pressure 80mm Hg 127 cases (81.94%), partial pressure of carbon dioxide 35mm Hg 47 cases (30.32%), 57 cases of PH7.45 (36.7%): white blood cells. 10 * 109/L 44 cases (28.39%), platelet 300 * 109/L 24 cases (15.48%). ECG and echocardiographic abnormalities including precordial T wave inversion, S1QIIITIII, right bundle branch block and right axis deviation respectively 21.05%, 12.50%, 9.21% and 7.89%, right ventricular enlargement and pulmonary hypertension, respectively accounted for 14.94% and 25.32%. common risk factors for braking, trauma, surgery, deep vein thrombosis and embolism history accounted for 34.84%, 15.48%, 12.90% and 7.09%. two Group comparison: PTE group of dyspnea, shortness of breath, cyanosis, two D- dimer, PO2, pCO2, S1QIIITIII, brake, deep venous thromboembolism were higher than those in non PE group (P0.05). The regression analysis of two classification Logistic: dyspnea and white blood cells 10 * 109/L as a risk factor; tumor platelet 300 * 109/L protective factors for pulmonary embolism. Conclusion the lack of specific clinical manifestations, white blood cell count can provide the basis for the risk stratification of pulmonary embolism, dyspnea, pulmonary embolism has a high diagnostic value, when the blood gas analysis in patients with hypoxemia accompanied by hypocapnia and elevated PH occurs, should be alert to the probability of pulmonary embolism.

【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R563.5

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