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目的 :总结急性肺栓塞 (APE)的临床特点 ,探讨治疗方法。方法 :对 60例APE临床资料进行回顾性分析。结果 :60例患者中呼吸困难 60例 (10 0 0 % ) ,紫绀 3 6例 (60 0 % ) ,肝大、双下肢浮肿 2 8例 (4 6 6% ) ,低血压 16例(2 6 6% ) ,胸痛、咳嗽、咯血 6例 (10 0 % ) ,P2 >A2 5 0例 (83 3 % ) ,发热、血沉增快 2 0例 (3 3 3 % )。近期心电图呈现明显右心室负荷增加者 2 4例 (4 0 0 % )、未见典型S1QⅢTⅢ 图形。胸片示右下肺动脉增宽、呈残根样改变者 12例 (2 0 0 % )。超声心动图示右房、室增大、右肺动脉增宽、压力增高者 48例 (80 0 % )。肺灌注扫描显示一个或多个肺段局限性灌注稀疏或缺损区 5 0例 (83 3 % )。血气分析氧分压 <60mmHg者 3 6例 (60 0 % )。B超探查下肢深静脉血栓形成者 6例(10 0 % )。结论 :APE临床表现是非特异性的 ,但如能结合临床、动态密切观察心电图改变、胸片、超声心动图、放射性核素等综合判断对APE的诊断是有帮助的。早期诊断、合适的治疗对改善预后有积极意义。
Objective: To summarize the clinical features of acute pulmonary embolism (APE) and discuss the treatment methods. Methods: The clinical data of 60 cases of APE were retrospectively analyzed. Results Sixty patients (60%) had dyspnea, 36 cases (60%) of cyanosis, 28 cases (46.6%) of liver enlargement, edema of both lower extremities and 16 cases of hypotension 6 cases of chest pain, cough and hemoptysis (100%), P2> 250 cases (83.3%), fever and 20 cases of erythrocyte sedimentation rate (33.3%). Recent ECG showed significant increase in right ventricular load in 24 cases (400%), no typical S1Q Ⅲ T Ⅲ pattern. The chest radiograph showed a widening of the right lower pulmonary artery, with 12 cases of residual root-like changes (200%). Echocardiography showed right atrium, ventricular enlargement, right pulmonary artery widening, pressure increased in 48 cases (80 0%). Lung perfusion scans showed localized perfusion or defect in one or more segments of the lungs in 50 patients (83.3%). Blood gas analysis oxygen partial pressure <60mmHg 36 cases (60%). B ultrasound exploration of deep venous thrombosis in 6 cases (100%). Conclusion: The clinical manifestations of APE are nonspecific. However, if combined with clinical and dynamic observation of ECG changes, the comprehensive evaluation of chest radiography, echocardiography and radionuclide is helpful in the diagnosis of APE. Early diagnosis, appropriate treatment to improve the prognosis has a positive meaning.