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目的探讨慢性阻塞性肺疾病(COPD)合并肺血栓栓塞症(PTE)的临床特点。方法收集本科2008年09月~2011年12月资料完整的COPD合并肺血栓栓塞症(PTE)病例26例,对其临床资料进行分析。结果慢性阻塞性肺病合并PTE总体临床特点无明显特异性,所有病例均出现呼吸困难加重、胸痛(61.5%)、咯血(42.3%)、胸腔积液(23.1%)、晕厥(11.5%)、下肢肿胀(7.7%),X线胸片检查5例出现肺周围形态不一的浸润性阴影;螺旋CT肺动脉造影(CTPA)检查26例均可见肺动脉充盈缺损;动脉血气分析检查26例均有低氧血症,Pa02<60 mmHg;D-二聚体阳性占69.2%;超声心动图检查表现为右心房扩大(19.2%),表现为右心房、室扩大(26.9%)和肺动脉压增高(61.5%);心电图不完全右束支传导阻滞(53.8%),完全性右束支传导阻滞(26.9%),SIQIIITIII(15.3%);下肢超声多普勒检查腘静脉血栓(46.2%),其中髂静脉血栓(7.7%)。结论两者合并发病时易被漏诊或误诊,因此对于COPD患者突然出现顽固性右心衰,或者吸入较高浓度的氧气,但PaO2仍<60 mmHg;或突发胸痛、咯血、出汗、头晕,尽快行肺动脉增强CT扫描、胸部肺动脉造影或磁共振肺动脉造影等检查进一步明确诊断,尽早治疗。
Objective To investigate the clinical features of chronic obstructive pulmonary disease (COPD) complicated with pulmonary thromboembolism (PTE). Methods A total of 26 COPD patients with pulmonary thromboembolism (PTE) were collected from September 2008 to December 2011, and their clinical data were analyzed. Results The overall clinical features of COPD with PTE had no obvious specificity. All patients had dyspnea with chest pain (61.5%), hemoptysis (42.3%), pleural effusion (23.1%), syncope (11.5%), Swollen (7.7%), X-ray examination in 5 cases showed invasive morphological changes around the lung shadow; spiral CT pulmonary angiography (CTPA) examination of 26 cases were visible pulmonary artery filling defect; arterial blood gas analysis of 26 cases were hypoxic Echocardiography showed right atrium enlargement (19.2%), manifested as right atrium, ventricular enlargement (26.9%) and pulmonary hypertension (61.5% ), Right bundle branch block (53.8%), complete right bundle branch block (26.9%), SIQIIITIII (15.3%), and lower extremity Doppler ultrasound (46.2%) Iliac vein thrombosis (7.7%). Conclusions The two were easily misdiagnosed or misdiagnosed when they were complicated by the disease. Therefore, patients with COPD suddenly developed refractory right heart failure or inhaled higher concentrations of oxygen but PaO2 was still <60 mmHg; or sudden chest pain, hemoptysis, sweating, dizziness As soon as possible pulmonary artery enhanced CT scan, chest pulmonary artery imaging or magnetic resonance pulmonary angiography and other tests to further confirm the diagnosis, early treatment.