目的：回顾性分析肺栓塞患者的临床症状、体征，危险因素、超声心动图及心电图特征。方法选取2013年1月—2015年7月解放军第474医院行CT肺血管造影（ CTPA）并诊断为肺栓塞的患者155例，记录患者的临床特点、危险因素、心电图、超声心动图检查结果。结果155例肺栓塞患者平均年龄（65．8±16．0）岁，常见临床特征为呼吸困难、咳嗽、胸痛，分别占62．58％、60．65％、34．19％。常见体征为呼吸急促、心率加快、发热、下肢不对称性水肿、发绀，分别占52．26％、29．03％、28．39％、21．29％、18．06％。 D－二聚体＞500μg／L 131例（84．52％）。血气分析：氧分压＜80 mmHg 127例（81．94％），二氧化碳分压＜35 mmHg 47例（30．32％），pH＞7．45者57例（36．7％）。血常规：白细胞＞10×109／L 44例（28．39％），血小板＞300×109／L 24例（15．48％）。心电图及超声心动图异常包括胸导联T波倒置、S1QIIITIII、右束支传导阻滞、电轴右偏分别占21．05％、12．50％、9．21％和7．89％，右室扩大及肺动脉高压，分别占14．94％和25．32％。常见危险因素为高龄制动、外伤、手术、深静脉血栓栓塞史分别占70．32％、34．84％、15．48％、12．90％和7．10％。就诊于呼吸内科103例（66．45％），心血管内科10例（6．45％），血液、内分泌科4例（2．58％），重症医学科5例（3．23％），急诊科3例（1．94％），外科（普外科、泌尿烧伤外科、骨科、神经外科）30例（19．35％）。接受单纯抗凝治疗患者139例（89．68％），静脉溶栓治疗10例（6．45％），介入取栓2例（1．29％）。院内死亡3例（1．94％）。4例放弃治疗。结论肺栓塞患者缺乏特异性临床特征，需与心肺疾病进行鉴别，结合患者危险因素、心电图及超声心动图等变化，有助于肺栓塞的诊断，并尽早给予抗凝或溶栓治疗，降低患者病死率。%Objective The clinical symptoms , signs, risk factors, echocardiography and ECG features of patients with pulmonary embolism were analyzed retrospectively .Methods From January 2013 to July 2015 , in the 474 th Hospital of PLA, 155 cases underwent CT pulmonary angiography ( CTPA) and were diagnosed as pulmonary embolism , record the clini-cal characteristics , risk factors, patient's electrocardiogram , echocardiogram .Result:155 cases of pulmonary embolism pa-tients with an average age (65.8 ±16.0) years old, the common clinical features of dyspnea , cough, chest pain, accounting for 62.58%, respectively, 60.65%, 34.19%.Common signs and symptoms of shortness of breath , heart rate, fever, lower extremity edema, cyanosis, asymmetry, accounted for 52.26%, 29.03%, 28.39%, 21.29%, 18.06%.D-dimer >500μg/L in 131 cases (84.52%).Blood gas analysis:oxygen partial pressure <80 mmHg in 127 cases, carbon dioxide partial pressure <35 mmHg in 47 cases (30.32%), pH>7.45 in 57 cases (36.7%).Blood leukocyte >10 ×109/L in 44 cases (28.39%), platelet >300 ×109/L in 24 cases (15.48%).The ECG and echocardiographic abnormalities including precor-dial T wave inversion, S1QIIITIII, right bundle branch block , right axis deviation accounted for 21.05%, 12.50%, 9.21%and 7.89%, right ventricular enlargement and pulmonary hypertension , respectively accounted for 14.94% and 25.32%. The common risk factors were 70.32%, 34.84%, 15.48%, and 7.10%, respectively for elderly patients with immobiliza-tion, trauma, surgery and deep venous thrombosis .Hospitalized in the respiratory department of 103 cases (66.45%), 10 cases of cardiology department (6.45%), 4 cases (2.58%) in department of Endocrinology , ICU of 5 cases (3.23%), 3 cases of the emergency department (1.94%), surgery (department of general surgery, department of orthopedics, department of Neurosurgery, department of urinary surgery) in 30 cases (19.35%).139 patients ( n =10) were treated with intrave-nous thrombolytic therapy (89.68%), and thrombectomy was performed in 2 patients (1.29%).3 cases (1.94%) died in hospital .4 cases gave up treatment .Conclusion The clinical features of patients with pulmonary embolism , lack of specifici-ty, should be differentiated from patients with pulmonary heart disease , risk factors, electrocardiogram and echocardiography changes contribute to the diagnosis of pulmonary embolism , and given anticoagulant or thrombolytic therapy as soon as possi-ble, reduce the mortality of patients .
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