【摘要】：目的探討急性肺栓塞患者預(yù)后不良的影響因素以及影響生存時間的危險因素方法對2004年1月至2013年12月上海復(fù)旦大學(xué)附屬中山醫(yī)院,經(jīng)CT肺動脈血管成像(computed tomography pulmonary angiography,CTPA)和(或)肺通氣灌注掃描確診的310例急性肺栓塞患者,進(jìn)行臨床資料的回顧性分析,對影響臨床療效的因素進(jìn)行多元logistics回歸分析;對上述患者出院后進(jìn)行生存時間隨訪,行Cox比例風(fēng)險回歸分析。結(jié)果310例急性肺栓塞患者,男性165例(53.2%),女性145例(46.8%)。年齡18-86歲,平均年齡(63.28±15.30)歲。臨床治療有效285例,治療無效25例。對急性肺栓塞患者的危險因素、臨床表現(xiàn)、實驗室檢查等資料進(jìn)行卡方檢驗,結(jié)果顯示以下7個變量在肺栓塞的臨床療效中存在差異:惡性腫瘤、神志精神改變、白細(xì)胞增高(WBC109/l)、低氧血癥(Pa O260 mm Hg)、低血壓(收縮壓90mm Hg)、肺栓塞分型、PESI評分(詳見表3)。以上述變量為自變量,建立多元logistic回歸分析顯示:在其他條件恒定的情況下,肺栓塞分型中的大面積肺栓塞、低氧血癥、白細(xì)胞增高和合并惡性腫瘤導(dǎo)致肺栓塞治療無效的危險性增加依次為22.625倍、10.915倍、8.120倍和5.142倍(詳見表4)。對上述310例肺栓塞患者出院后進(jìn)行生存時間隨訪,共收集到81例門診及電話隨訪結(jié)果,隨訪時間0.5-24個月,平均隨訪時間(22.59±19.27)個月,共有28例患者死亡,生存53例。建立Cox比例風(fēng)險回歸模型顯示肺動脈收縮壓增高(≥50mm Hg)發(fā)生死亡的危險度是未增高組(50mm Hg)的9.240倍(95%CI:2.307~37.013),提示肺動脈收縮壓增高者(≥50mm Hg)在長期生存方面劣于肺動脈壓未增高者;相同肺動脈收縮壓水平下,合并惡性腫瘤發(fā)生死亡的危險度是非惡性腫瘤患者的3.7倍(95%CI:1.010~13.562)(詳見表5)。結(jié)論大面積肺栓塞、低氧血癥、白細(xì)胞增高、合并惡性腫瘤可能是肺栓塞預(yù)后不良的影響因素。肺動脈收縮壓增高(≥50mm Hg)、合并惡性腫瘤對生存時間影響明顯,且發(fā)生死亡的風(fēng)險增大。
[Abstract]:Objective to investigate the risk factors of poor prognosis in patients with acute pulmonary embolism. Methods from January 2004 to December 2013, Zhongshan Hospital affiliated to Fudan University, Shanghai, underwent CT pulmonary artery angiography (computed tomography pulmonary angiography,). The clinical data of 310 patients with acute pulmonary embolism diagnosed by CTPA and / or pulmonary ventilation perfusion scanning were analyzed retrospectively and the factors affecting the clinical efficacy were analyzed by multivariate logistics regression analysis. The survival time was followed up after discharge and Cox proportional risk regression analysis was performed. Results among 310 patients with acute pulmonary embolism, 165 (53.2%) were male and 145 (46.8%) were female. The average age was (63.28 鹵15.30) years. Clinical treatment was effective in 285 cases and ineffective in 25 cases. The data of risk factors, clinical manifestation, laboratory examination and so on in patients with acute pulmonary embolism were tested by chi-square test. The results showed that there were differences in the clinical efficacy of the following seven variables in the treatment of pulmonary embolism: malignant tumor, mental and mental changes, and so on. Leucocytosis (WBC109/l), hypoxemia (Pa O 260 mm Hg), hypotension (type of pulmonary embolism of systolic blood pressure 90mm Hg), PESI score) (see table 3 for more details). Using the above variables as independent variables, a multivariate logistic regression analysis was established. The results showed that large area pulmonary embolism and hypoxemia were found in the classification of pulmonary embolism under the condition of constant other conditions. The risk of pulmonary embolism was increased by 22.625 times, 10.915 times, 8.120 times and 5.142 times respectively due to leukocytosis and malignant tumor (see table 4 for details). The survival time of 310 patients with pulmonary embolism was followed-up after discharge. 81 patients were followed up by telephone and outpatient service. The follow-up time was 0.5-24 months (mean 22.59 鹵19.27) months, and 28 patients died. 53 cases survived. Cox proportional risk regression model showed that the risk of death in patients with elevated pulmonary artery systolic blood pressure (鈮，

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