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目的:分析老年急性肺栓塞（APE）患者的临床特点、诊治及结局，以加强APE诊断意识，减少漏诊及误诊。方法:回顾性分析2008年1月至2018年12月在泰达国际心血管病医院收治的APE老年（年龄≥60岁）确诊患者的临床资料，包括危险因素、临床症状和体征、实验室检查、肺栓塞临床可能性评分（Wells评分）、简化肺栓塞严重指数（sPESI）、影像学检查、治疗与转归等。绘制受试者工作特征曲线（ROC）分析Wells评分和螺旋CT肺动脉造影（CTPA）对APE的诊断价值。结果:入选40例老年APE患者，男性占52.5%，年龄（69.6±8.2）岁；主要危险因素为深静脉血栓形成（DVT，52.5%），其次为高血压（37.5%）、心力衰竭（35.0%）；主要临床症状为劳力性呼吸困难（87.5%）、胸闷（80.0%），仅有10.0%的患者同时出现呼吸困难、胸痛、咯血三联征，心悸（65.0%）和下肢肿痛（42.5%）也是常见症状；主要临床体征为呼吸急促（呼吸频率>25次/min，80.0%）、肺部湿啰音（52.5%）、心动过速（心率>100次/min，50.0%）。Wells评分评估患病可能性显示，95%的患者评分≥2分，其中中度可能性患病（2～6分）占62.5%，高度可能性患病（≥7分）占32.5%。实验室检查显示，80.0%的患者D -二聚体>0.5 mg/L，72.5%动脉血氧分压（PaOn 2）300 ng/L，47.5%心肌肌钙蛋白I（cTnI）>0.3 μg/L。经CTPA确诊率为88.6%（31/35）；6例行肺通气/灌注显像确诊5例；4例行核磁共振肺动脉造影（MRPA）确诊。用sPESI评估病情程度显示，36例患者为中危〔sPESI≥1分26例，sPESI 0分但伴有右室功能不全（RVD）和（或）心脏生物学标志物升高10例〕，其中17例行溶栓+抗凝治疗，结果治愈8例，好转8例，死亡1例；18例行抗凝治疗，结果治愈9例，好转7例，自动出院1例，死亡1例；1例右房黏液瘤致PE者行手术治疗，但最终死亡。另外4例低危患者均行抗凝治疗，治愈2例，好转2例。Wells评分联合CTPA确诊APE的ROC曲线下面积（AUC）为0.82（95%可信区间为0.73～0.98，n P 25 bpm, 80.0%), lung moist rales (52.5%), and tachycardia (heart rate > 100 bpm, 50.0%). The Wells score showed that 95% of the patients Wells ≥ 2, including moderate (Wells 2-6, 62.5%) and severe (Wells ≥ 7, 32.5%). Laboratory examination showed that 80.0% of patients had D-dimer > 0.5 mg/L, 72.5% had arterial partial pressure of oxygen (PaO n 2) 300 ng/L, and 47.5% had cardiac troponin I (cTnI) > 0.3 μg/L. The confirmed diagnosis rate of CTPA in APE was 88.6% (31/35); 5 cases were diagnosed by pulmonary ventilation/perfusion imaging in 6 cases; 4 cases were diagnosed by magnetic resonance pulmonary angiography (MRPA). The sPESI score showed that 36 patients were moderate-risk patients [26 patients with sPESI ≥ 1, and 10 patients with sPESI 0 but right ventricular dysfunction (RVD) and/or elevated cardiac biomarkers]. Thrombolytic therapy and anticoagulant therapy were performed on 17 of them: 8 were cured, 8 were improved, and 1 died; anticoagulant therapy was performed on 18 moderate-risk patients: 9 were cured, 7 were improved, 1 left the hospital without cure, and 1 died; the other 1 moderate-risk patient with PE caused by right atrial myxoma was treated by operation and ultimately died. Four low-risk patients were treated by anticoagulant therapy: 2 were cured and 2 improved. The area under the ROC curve (AUC) of Wells score combined with CTPA was 0.82 (95% confidence interval was 0.73-0.98, n P < 0.01), the sensitivity was 74.2%, and the specificity was 90.0%.n Conclusions:DVT and chronic diseases are the most common risk factors for APE in the elderly patients, often accompanied by dyspnea, chest tightness, and lower limb swelling and pain. Early anticoagulation therapy in elderly APE can make a good prognosis. Wells score has an important predictive value for the diagnosis of APE, while blood D-dimer is an important exclusion parameter. CTPA test is the main diagnostic method for APE. The sPESI score can suggest risk stratification and prognosis, and further guided treatment.