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目的总结急性肺动脉栓塞的临床症状、诊断和治疗方法。方法选取2008年6月-2010年6月在我院确诊为急性肺动脉栓塞42例患者为研究对象,对其临床症状、诊断方法进行统计分析。结果不明原因的呼吸困难及气促的患者有36例,胸痛患者29例,晕厥患者5例,小量咯血6例,大咯血1例,咳嗽3例。血浆D-二聚体检查敏感性为92.86%(39/42)。心电图分析:窦性心动过速的患者有31例,出现V1-V4的T波倒置和ST段异常的患者24例,完全性右束支传导阻滞的患者12例,不完全性右束支传导阻滞的患者6例,肺型P波的3例。在螺旋CT检测中,仅有1例患者的CT显示正常。肺灌注扫描中,高度可能的患者37例,非诊断性异常的患者3例,正常患者1例。接受溶栓治疗的临床症状完全缓解率66.67%,死亡率8.3%;接受普通肝素治疗的一组中,完全缓解率55.56%,死亡率5.5%。溶栓治疗的完全缓解率和接受抗凝治疗的完全缓解率有统计学差异,死亡率没有统计学差异。结论急性肺动脉栓塞单从临床症状上难以确诊,症状缺乏特异性;在诊断方面,建议先行D-二聚体对疑诊的患者进行筛查,再行螺旋CT进行确诊;治疗效果方面,溶栓治疗也优于抗凝治疗,只要没有溶栓的禁忌症,尽量采用溶栓治疗以得到理想疗效。
Objective To summarize the clinical symptoms, diagnosis and treatment of acute pulmonary embolism. Methods Forty-two patients diagnosed as acute pulmonary embolism in our hospital from June 2008 to June 2010 were selected as the research object, and their clinical symptoms and diagnosis were statistically analyzed. Results unexplained dyspnea and shortness of breath in patients with 36 cases, 29 cases of chest pain, 5 cases of syncope, small hemoptysis in 6 cases, 1 case of massive hemoptysis, cough in 3 cases. Plasma D-dimer test sensitivity was 92.86% (39/42). ECG analysis: There were 31 patients with sinus tachycardia, 24 patients with abnormal T-wave inversion and ST-segment abnormalities in V1-V4, 12 patients with complete right bundle branch block, incomplete right bundle branch 6 cases of conduction block, 3 cases of pulmonary P wave. In spiral computed tomography, CT was normal in only 1 patient. In the lung perfusion scan, 37 were highly probable patients, 3 were non-diagnostic abnormalities, and 1 was normal. Thrombolytic therapy of clinical symptoms complete remission rate of 66.67%, the mortality rate of 8.3%; received unfractionated heparin in a group, the complete remission rate was 55.56%, the mortality rate of 5.5%. The complete remission rate of thrombolytic therapy and complete remission rate after receiving anticoagulant therapy were statistically different, and the mortality rate was not statistically different. Conclusions Acute pulmonary embolism alone is difficult to diagnose from clinical symptoms, and the symptoms are not specific. In the diagnosis, it is recommended that D-dimer be used to screen the suspected patients before spiral CT, and the therapeutic effect of thrombolysis Treatment is also superior to anticoagulant therapy, as long as no thrombolytic contraindications, try to use thrombolytic therapy in order to obtain the desired effect.