【摘要】：目的:肺血栓栓塞癥(pulmonary thromboembolism,PTE)為一種潛在的致命性疾病,許多患者至死后尸檢才得以明確診斷。本文通過了解PTE尸檢臨床及病理特點,以提高對PTE的認識。方法:采用回顧性研究方法,收集47例PTE病例的一般情況、基礎疾病及誘因、臨床表現(xiàn)、臨床診治、尸檢血栓部位,總結分析臨床及病理特點。結果:1)12年間共完成尸檢784例,其中PTE 47例(2例合并脂肪栓塞),發(fā)生率6.0%。47例尸檢PTE中有46例為致死性肺栓塞(fatal pulmonary embolism,FPE)(97.9%);2)分析47例PTE尸檢資料發(fā)現(xiàn),每例均至少存在一項危險因素,43例(91.5%)存在2項及以上危險因素,其中最常見危險因素為創(chuàng)傷骨折(26例,55.3%)及手術(25例,53.2%)。臨床癥狀以呼吸困難(19例,40.4%)、心搏驟停(15例,31.9%)及暈厥(13例,27.7%)常見。24例(51.1%)合并下肢深靜脈血栓形成(deep vein thrombosis,DVT),10例(21.3%)合并右心血栓,1例(2.1%)合并基底動脈血栓。栓塞部位以肺動脈主干多見(28例,59.6%),其中騎跨型肺栓塞20例(42.6%)。47例患者中22例(46.8%)死前疑診為PTE,但均未行抗凝或溶栓治療,僅1例予低分子肝素預防血栓形成。結論:PTE容易繼發(fā)于有高危因素的患者,尤其是創(chuàng)傷骨折及手術。其臨床癥狀無特異性,缺乏典型三聯(lián)征,誤診率、漏診率及致死率極高,臨床工作者對PTE診治意識不足。
[Abstract]:Objective: pulmonary thromboembolism (pulmonary thromboembolism,PTE) is a potentially fatal disease. The clinical and pathological features of PTE autopsy were studied in order to improve the understanding of PTE. Methods: a retrospective study was carried out in 47 cases of PTE. The clinical manifestations, clinical diagnosis and treatment, and the location of thrombus in autopsy were collected, and the clinical and pathological features were summarized and analyzed. Results A total of 784 autopsy cases were completed in 12 years, of which 47 cases were PTE (2 cases with fat embolism), 46 cases of PTE were fatal pulmonary embolism (fatal pulmonary embolism,FPE) (97.9%) in 6.0.47 cases of PTE. There were at least one risk factor in 43 cases (91.5%). The most common risk factors were traumatic fracture (26 cases, 55.3%) and surgery (25 cases, 53.2%). The clinical symptoms were dyspnea (19 cases, 40.4%), cardiac arrest (15 cases, 31.9%) and syncope (13 cases, 27.7%). 24 cases (51.1%) were complicated with (deep vein thrombosis,DVT), 10 cases (21.3%) with right cardiac thrombosis and 1 case (2.1%) with right cardiac thrombosis and basilar artery thrombosis. Pulmonary artery trunk was the most common site of embolism (28 cases, 59.6%). Among them, 20 cases (42.6%) had straddle pulmonary embolism. 22 cases (46.8%) had suspected PTE, before death, but none of them were treated with anticoagulant or thrombolytic therapy, only 1 case was treated with low molecular weight heparin to prevent thrombosis. Conclusion: Pte may be secondary to patients with high risk factors, especially trauma fracture and surgery. Its clinical symptoms are nonspecific, lack of typical triple sign, misdiagnosis rate, missed diagnosis rate and fatality rate are very high, clinical workers have insufficient consciousness of diagnosis and treatment of PTE.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R563.5

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