本文選題：急性肺栓塞 + 診斷��； 參考：《石河子大學(xué)》2013年碩士論文

【摘要】：目的：分析急性肺栓塞（acute pulmonary embolism，APE）的臨床特點(diǎn)，并觀察溶栓和抗凝治療的臨床安全性，以減少誤診率和漏診率，及時(shí)給予安全有效的治療措施。 方法：采用回顧性分析方法，收集新疆石河子大學(xué)醫(yī)學(xué)院第一附屬醫(yī)院2008年1月-2012年2月收治的52例急性肺栓塞的住院患者的一般資料、住院時(shí)間、易患因素、臨床表現(xiàn)、實(shí)驗(yàn)室及影像學(xué)檢查結(jié)果以及治療方法與轉(zhuǎn)歸等臨床資料，統(tǒng)計(jì)各臨床資料的發(fā)生頻率，并應(yīng)用統(tǒng)計(jì)學(xué)方法分析不同治療方法的治療效果以及預(yù)后情況。 結(jié)果： 1.老年患者（60歲）、吸煙、下肢靜脈疾病、手術(shù)、高血壓病、冠心病是肺栓塞常見的易患因素，，兩個(gè)以上危險(xiǎn)因素的有40例。 2.最常見癥狀為呼吸困難，其次為胸痛、咯血和咳嗽，其中咯血患者11例（21.2%），無大咯血發(fā)生。50%以上患者查體可發(fā)現(xiàn)呼吸急促和心動過速。12例患者(22.2%)出現(xiàn)DVT（deep venous thrombosis）征。另外，典型的呼吸困難、咯血、胸痛三聯(lián)征只見于5例（9.6%）APE患者。 3.動脈血?dú)夥治霭l(fā)現(xiàn)低氧血癥（（PaO_210.7kPa/80mmHg）（即氧分壓80mmHg）42例(93.3%)。 4.免疫比濁法定量檢驗(yàn)，其中45例（95.7%）D-二聚體結(jié)果0.5ug/ml。 5.X線胸片有繼發(fā)肺組織改變的96%。心電圖有特異性改變典型的S_IQ_(III)T_(III)征6.1%，竇性心動過速陽性率為61.2%，胸導(dǎo)聯(lián)T波倒置28.6%，RBBB/IRBBB6.1%。 6.超聲心動圖發(fā)現(xiàn)肺動脈高壓13例（31.0%)，右室壁運(yùn)動減退12例(28.6%)，三尖瓣返流15例（35.7%），右心室擴(kuò)大7例（16.7%)，心包積液1例（2.4%)。多普勒血管超聲發(fā)現(xiàn)12例靜脈血栓形成。 7.CT肺動脈造影（computed tomography pulmonary angiography，CTPA）48例發(fā)現(xiàn)肺動脈和/或分支充盈缺損的改變，其中右肺下葉47例，上葉40例，中葉29例，左肺下葉38例，上葉32例。 8.溶栓治療有效率為71.4%，抗凝治療有效率為97.1%，一般處理無效。溶栓組并發(fā)出血者5例，抗凝組并發(fā)出血者4例。入選的5例維吾爾族病例藥物治療量相比漢族偏大，INR達(dá)標(biāo)時(shí)間長。 結(jié)論：對于年齡60歲、長期吸煙、心血管疾病、下肢靜脈疾病、手術(shù)與肥胖患者，應(yīng)視為急性肺栓塞的高危人群并定期篩查，及早預(yù)防栓塞的發(fā)生、發(fā)展。CTPA可作為確診肺栓塞的首選檢查手段，而D-dimer、血?dú)夥治�、超聲心動圖（echocardiography，ECHO）等可作為輔助診斷手段。大面積急性肺栓塞患者治療有效率低于非大面積及次大面積。溶栓和抗凝治療是APE有效的治療手段，可顯著降低其死亡率。5例維吾爾族患者相比入選的漢族患者而言，藥物的治療量偏大，INR達(dá)標(biāo)時(shí)間延長。種族因素可能對藥物治療劑量有影響，需進(jìn)一步研究探討。
[Abstract]:Objective: to analyze the clinical characteristics of acute pulmonary embolism (acute pulmonary) and to observe the clinical safety of thrombolysis and anticoagulant therapy in order to reduce the misdiagnosis rate and miss diagnosis rate and to give safe and effective treatment measures in time. Methods: the general data, hospitalization time, risk factors and clinical manifestations of 52 patients with acute pulmonary embolism admitted from January 2008 to February 2012 in the first affiliated Hospital of Medical College of Shihezi University of Xinjiang were retrospectively analyzed. The results of laboratory and imaging examination as well as the clinical data such as treatment methods and outcomes were analyzed. The frequency of occurrence of each clinical data was counted and the therapeutic effect and prognosis of different treatment methods were analyzed by statistical method. Results: 1. Elderly patients (60 years old), smoking, lower extremity venous disease, surgery, hypertension, coronary heart disease are common risk factors for pulmonary embolism, more than two risk factors in 40 cases. The most common symptom was dyspnea, followed by chest pain, hemoptysis and cough. Among them, 11 cases (21.2%) had hemoptysis. In addition, typical dyspnea, hemoptysis and chest pain were found in 5 cases (9.6%) of ape patients. Arterial blood gas analysis showed that 42 cases (93.3%) were hypoxemia (Pao _ 2 10.7 KPA / 80 mmHg) (i.e. oxygen partial pressure 80 mmHg). The results of immunoturbidimetry showed that 45 cases (95.7%) of D-dimer showed 0.5ugmml.5.The chest radiographs had 96% of secondary lung tissue changes. The typical SIQIII T _ (III) sign was 6.1, the positive rate of sinus tachycardia was 61.2, and T wave inversion of T wave in chest lead was 28.6B / BBIRB6.6. Echocardiography revealed pulmonary hypertension in 13 cases (31.0%), right ventricular wall motion loss in 12 cases (28.6%), tricuspid regurgitation in 15 cases (35.7%), right ventricular dilatation in 7 cases (16.7%), pericardial effusion in 1 case (2.4%). 12 cases of venous thrombosis were detected by Doppler angiography. 7. Ct pulmonary angiography (computed tomography pulmonary) revealed the defect of pulmonary artery and / or branches in 48 cases, including 47 cases of right inferior lobe, 40 cases of superior lobe, 29 cases of middle lobe, 38 cases of left lower lobe. Upper lobe 32 cases. The effective rate of thrombolytic therapy was 71.4 and the effective rate of anticoagulant therapy was 97.1.The general treatment was ineffective. Bleeding occurred in 5 cases in thrombolytic group and 4 cases in anticoagulant group. The dosage of drug therapy in 5 Uygur cases was longer than that in Han nationality. Conclusion: patients aged 60 years with chronic smoking, cardiovascular disease, venous disease of lower extremity, surgery and obesity should be regarded as high risk group of acute pulmonary embolism and be screened regularly to prevent embolism as early as possible. CTPA can be used as the first choice in the diagnosis of pulmonary embolism, and D-dimer, blood gas analysis, echocardiography and echo can be used as auxiliary diagnostic methods. The effective rate of large-area acute pulmonary embolism was lower than that of non-large and sub-large pulmonary embolism. Thrombolytic therapy and anticoagulant therapy are effective treatment methods for ape, which can significantly reduce the mortality rate of 5 cases of Uygur patients compared with the selected Han nationality patients, the amount of drug treatment is too large and the time of reaching the standard of INR is longer than that of the selected Han nationality patients. Racial factors may have an effect on the dosage of drug therapy and need further study.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R563.5

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