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目的总结15例肺血栓栓塞患者的诊断和治疗经验。方法分析新乡市中心医院2008年6月—2009年11月15例肺血栓栓塞患者的的临床表现、胸部影像学特征及实验室检查结果。结果 15例患者行CT肺血管造影,全部明确诊断为肺动脉栓塞;临床表现主要是胸闷、胸痛、气短、呼吸困难、心悸,其次是晕厥,下肢疼痛肿胀;血气分析主要表现为低氧血症,其中12例患者D-二聚体监测阳性,心电图、超声心动图及四肢血管彩超检查都有一定的异常;其中12例患者经溶栓及抗凝治疗,11例治愈,1例死亡,余3例仅给予抗凝治疗。结论 CT肺血管造影能明确诊断,危重患者及高危险患者血气分析、D-二聚体、心电图、四肢血管彩超、超声心动图、X线检查等全面综合分析能有效提高肺栓塞诊断率,早期溶栓及抗凝治疗可以达到较好的治疗效果。
Objective To summarize the diagnosis and treatment experience of 15 patients with pulmonary thromboembolism. Methods The clinical manifestations, chest radiographic features and laboratory findings of 15 patients with pulmonary thromboembolism from June 2008 to November 2009 in Xinxiang Central Hospital were analyzed. Results CT pulmonary angiography was performed in all 15 cases, all of them were diagnosed as pulmonary embolism. The main clinical manifestations were chest tightness, chest pain, shortness of breath, dyspnea, palpitations, followed by syncope and lower extremity pain. Blood gas analysis mainly included hypoxemia, Twelve of them were positive for D-dimer, and electrocardiogram, echocardiography and vascular color Doppler were all abnormalities. Among them, 12 were thrombolytic and anticoagulant therapy, 11 were cured, 1 died, and the remaining 3 Cases only given anticoagulant therapy. Conclusion CT pulmonary angiography can make a definite diagnosis. The comprehensive analysis of blood gas analysis, D-dimer, electrocardiogram, extremity vascular ultrasound, echocardiography and X-ray examination in critically ill patients and high-risk patients can effectively improve the diagnostic rate of pulmonary embolism. Thrombolysis and anticoagulant therapy can achieve better therapeutic effect.