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目的:分析高原地区急性肺栓塞的临床特征,提高基层医院内外科医师对肺栓塞的认识。方法:分析青海省大通县医院感染科2006年6月—2009年9月收治的4例急性肺栓塞患者的临床诊治情况。结果:4例都存在强易患因素——右下肢股骨干骨折管状石膏固定1月伴双下肢不对称水肿1例、双下肢严重创伤伴卧床1个月,双下肢静脉严重曲张第二次手术后2周1例,右髋骨骨折手术后第二天1例。出现呼吸道症状(1～3)天,临床表现为:呼吸困难3例,胸痛2例,咳嗽3例,痰中带血1例,咯血2例,右心衰竭1例,影像学特点呈片絮状阴影3例及右侧少量胸腔积液1例,误诊肺结核3例,1例胸膜炎。结论:重视高原地区急性肺栓塞的高危因素,综合临床症状和体征的采集和分析,熟悉诊治流程,及时规范治疗,早期积极预防,减少发病率、误诊及漏诊率,改善患者预后,降低病死率。
OBJECTIVE: To analyze the clinical features of acute pulmonary embolism in high altitude area and to improve the understanding of pulmonary embolism among surgeons in primary hospitals. Methods: The clinical diagnosis and treatment of 4 cases of acute pulmonary embolism admitted from Datong County Hospital Infection Department of Qinghai Province from June 2006 to September 2009 were analyzed. Results: There were strong predisposition factors in all the 4 cases: the right lower extremity femoral shaft fractures were fixed with tubular plaster in January with asymmetric edema of both lower extremities in 1 case, severe lower extremities trauma and bed rest in 1 month, 1 case after 2 weeks and 1 case the right hip fracture the day after surgery. Respiratory symptoms (1-3 days), the clinical manifestations were: dyspnea in 3 cases, 2 cases of chest pain, cough in 3 cases, bloody sputum in 1 case, hemoptysis in 2 cases, right heart failure in 1 case, imaging features were piece flakes 3 cases of shadow and a small amount of right pleural effusion in 1 case, 3 cases of misdiagnosed tuberculosis, 1 case of pleurisy. CONCLUSION: It is important to pay attention to the risk factors of acute pulmonary embolism in the plateau, to collect and analyze the clinical symptoms and signs, to be familiar with the diagnosis and treatment process, to standardize the treatment in time, to actively prevent and reduce the incidence, misdiagnosis and misdiagnosis rate, to improve the prognosis and to reduce the mortality rate .