發(fā)布時間：2018-05-11 09:35

  本文選題：肺血栓栓塞癥 + 危險因素�。� 參考：《山東中醫(yī)藥大學》2012年碩士論文

【摘要】：目的:分析肺血栓栓塞癥（PTE）的危險因素、臨床表現、實驗室檢查,方法和預后，提高對其的認識和診斷水平，從而進一步提高治愈率，減少誤診率和漏診率。 方法：回顧性分析2009年10月至2012年4月88例確診為肺血栓栓塞患者的臨床資料。 結果：1.96.5%的患者存在高危因素，最常見的危險因素或基礎疾病為下肢深靜脈血栓形成/曲張（47.7%），其次為冠心�。�39.7%），高血壓（34.1%），感染（30.7%），COPD（22.7%），惡性腫瘤（18.1%），手術（17%），糖尿�。�14.7%），骨折（12.5%），結締組織病8例（9%），甲亢7例（7.96%），長期臥床者2例（2.3%）。 2.最常見的癥狀為呼吸困難61例（69.3%），其次為胸痛30例（34.1%），咳嗽26例（29.5%），咯血6例（6.8%），暈厥2例（2.3%），，呼吸困難、胸痛、咯血同時出現（肺梗死）者5例（5.7%）。最常見的體征為肺部羅音22例（25%），其次為胸腔積液12例（13.6%），，紫紺11例（12.5%）， P2亢進10例（11.4%），下肢腫脹10例（11.4%），發(fā)熱7例（8.0%），皮膚瘀斑1例（1.14%）。 3.輔助檢查：（1）實驗室檢查：60例患者行D-二聚體檢查，其中45例500μg|L（75%）。73例患者行血氣分析檢查,52例(71.2%),動脈血氧分壓(PaO2)下降60mmHg;50例(68.4%)動脈血二氧分壓(Pa CO2)下降35mmHg，，血氧飽和度(Sa02)＜95%者69例(94.5%)。30例患者行血沉檢測，其中24例（80%）高于正常。（2）超聲心動圖：其中有62例PTE間接征象，肺動脈壓力增高(35mmHg)共50例,占56.2%,其中輕度肺動脈高壓(36~50mmHg)18例,占20.2%,中度肺動脈高壓(50~70mmHg)17例,占19.1%,重度肺動脈高壓(70mmHg)15例,占16.9%。（3）心電圖：60例有不同程度變化，竇性心動過速33例（55%），ST－T改變4例（6.7%），SⅠQⅢTⅢ18例(30%),房顫5例（8.3%），右束支傳導阻滯3例（5%）。（4）胸部X線和下肢血管彩超X線胸片示胸腔積液12例（13.6），58例PTE患者行下肢靜脈超聲檢查,有35例（60.3%）下肢深靜脈血栓形成。 4.治療和預后88例患者中治愈37例，顯效22例，好轉17例，死亡1例，無效3例。 結論：肺血栓栓塞的臨床表現多種多樣，易造成漏診和誤診，因此提高對肺血栓栓塞的認識，進行早期干預治療，可降低死亡率。
[Abstract]:Objective: to analyze the risk factors, clinical manifestations, laboratory examination, methods and prognosis of pulmonary thromboembolism (PTE), and to improve the understanding and diagnosis of PTEs, so as to further improve the cure rate and reduce the misdiagnosis rate and missed diagnosis rate. Methods: the clinical data of 88 patients with pulmonary thromboembolism from October 2009 to April 2012 were retrospectively analyzed. Results 1.96. 5% of the patients had high risk factors. The most common risk factors or underlying diseases were deep venous thrombosis / varices of the lower extremities 47.7am, coronary heart disease 39.7m, hypertension 34.1m, infection 30.77.7m, malignant tumor 18.1C, surgical operation 175.The incidence of diabetes 14.7m, fracture 12.5m, connective tissue disease 8 cases, hyperthyroidism 7.96m 7 cases, and chronic bed rest 2 cases with diabetes 2.30.The most common risk factors or basic diseases were: deep vein thrombosis / varices 47.7am, coronary heart disease 39.7%, hyperthyroidism 7 cases, hyperthyroidism 7.967%, and chronic bed rest 2 cases. 2. The most common symptoms were dyspnea in 61 cases (69.3%), chest pain in 30 cases (34.1%), cough in 26 cases (29.5m), hemoptysis in 6 cases (6.8%), syncope in 2 cases (2.3%), dyspnea, chest pain and hemoptysis (pulmonary infarction) in 5 cases. The most common signs were lung rales in 22 cases, pleural effusion in 12 cases, cyanosis in 11 cases, P 2 in 10 cases, in 10 cases of swelling of lower limbs, in 7 cases of fever, and in 1 case of ecchymosis, 1 case of ecchymosis, and 1 case of ecchymosis. 3. Assistant examination: 1) Laboratory examination: 60 patients underwent D- dimer examination. Among them, 45 patients (500 渭 g / L) and 73 patients were examined by blood gas analysis. 52 patients were found to have a blood gas analysis and 52 patients had a decrease of Pao 2 (60 mm Hg2) and 50 patients had a decrease of 60 mm Hg2 (P < 68.4 mm). The arterial partial pressure of oxygen (Pao 2) was decreased by 35 mm Hgn. The blood oxygen saturation (Sa02) was less than 95%. 69 cases (94.55%) were examined for erythrocyte sedimentation rate (ESR). Among them, there were 62 cases with indirect signs of PTE and 35 mm Hg of pulmonary hypertension (56.2 mm), of which 18 cases (20.2mm) were mild pulmonary hypertension, 17 cases (19.1mm) were moderate pulmonary hypertension, 15 cases were severe pulmonary hypertension (70mm Hgg), 18 cases (20.2mm) were mild pulmonary hypertension, 17 cases (19.1mm) were moderate pulmonary hypertension. The electrocardiogram of 60 cases has varying degrees. ST-T changes in 33 cases of sinus tachycardia (n = 33) and changes of ST-T in 4 cases (6. 7) including 30 cases with S 鈪

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