急性肺栓塞死亡患者临床特点分析

摘要

目的 分析因急性肺动脉血栓栓塞死亡患者的临床特点,探讨高危患者的早期评估方法.方法 1997年6月至2010年12月在我院因急性肺栓寒死亡的住院患者31例,回顾性分析此类患者的临床特点.结果 31例患者肺栓塞从发病到死亡时间为2 h～11 d,其中合并慢性阻塞性肺疾病9例(29.1％)、高血压病16例(51.6％)、冠心病11例(35.5％)、2型糖尿病8例(25.8％)、脑梗死5例(16.1％)、肺部感染16例(51.6％).7例(22.6％)表现为呼吸心跳骤停,其余患者最常见的症状为呼吸困难(24例,77.4％),24例(77.4％)在起病初始出现血压下降.28例(90.3％)D二聚体＞500μ,19例(61.3％) LDH升高,10例(32.3％)cTNI升高,6例(19.4％) AST升高.15例(48.4％)患者心电图出现典型QⅢTⅢSⅠ改变,仅出现QⅢ或SⅠ者15例(48.4％),发生呼吸心跳骤停的7例患者中,5例最初心电图表现为室性逸搏.5例存活超过3天的患者超声心动图可见右心室功能障碍表现.结论 急性肺栓塞死亡患者中,呼吸困难、低血压、心电图呈特征性QⅢTⅢSⅠ改变是最为常见的临床特征,预后不佳,合理利用床边简便检查方法对于尽早识别高危患者、评估预后非常重要.%Objective To analyze the clinical features of the patients who death due to acute pulmonary embolism and discuss the early assessment method of high risk patients with pulmonary embolism.Methods From June 1997 to December 2010,31 cases suffered acute pulmonary embolism and eventual death.The clinical features of these patients were retrospectively analyzed.Results The time from onset to death of 31 patients were 2 hours to lldays.In these patients,29.1％ associated with COPD,51.6％ with hypertension,35.5％ with coronary heart disease,25.8％ with type 2 diabetes,16.1％ with cerebral infarction,and 51.6％ with lung infection.7 patients suffered respiratory and cardiac arrest.The most common symptoms were shortness of breath (24 cases,77.4％ ).The blood pressure of 77.4％ patients dropped in the initial onset.In D-dimer test,90.3％ patients' is over ＞500 μg/ml.In the indicators of serum enzymes,LDH of the 61.3％ patients increased,cTNI of 32.3％ patients increased,and AST of the 19.4％ patients increased.The ECG of 48.4％ patients appeared QⅢTⅢSⅠ features,also 48.4％ patients showed only QⅢ or SI features.In the patients with respiratory and cardiac arrest,the initial ECG in 5 cases appeared ventricular escape beat.In 5 cases of patients surviving more than 3 days,the UCG showed the performance of right ventricular dysfunction.Conclusion In the patients death due to acute pulmonary embolism,the mostcommon characters were shortness of breath,low blood pressure and QⅢTⅢSⅠ/QⅢ/SⅠ in ECG.The prognosis of them was poor.Rational use of simple bedside examination methods was very important to early identification of high-risk patients and assessing prognosis.