Objective To analyze the clinical characteristics of the elderly acute pulmonary embolism(APE) patients with normal blood pressure and right ventricular dysfunction(RVD).Methods A total of 133 elderly APE patients with normal blood pressure and RVD were retrospectively analyzed.According to whether or not to merge RVD,patients were divided into the RVD group(n=42)and the non-RVD group(n=91).The incidence of clinical symptoms and signs,the incidence of pulmonary embolism,clinical indicators after thrombolytic therapy,and the incidence of bleeding were compared and analyzed between RVD and non-RVD groups.Results The incidences of syncope(33.3％ or 14/42 vs.7.8％ 7/91),P2 accentuation(45.2％ or 19/42 vs.25.3％ or 23/91),tachycardia(40.5％ or 17/42 vs.20.9％ or 19/91),cyanosis(26.2％ or 11/42 vs.8.8％ or 8/91)and jugular vein filling(11.9％ or 5/42 vs.1.1％ or 1/91)had significant differences between RVD and non-RVD groups(x2 =4.928,4.644,5.410,4.971 and 4.163,all P＜0.05).The incidence of proximal pulmonary embolism was higher in RVD group than in non-RVD group[25(59.5％)vs.8(8.8％),x2 =13.636,P＜0.01],and the incidence of lobar artery embolism was higher in RVD group than in non-RVD group[32 (76.2％)vs.47(51.6％),x2 =9.530,P＜0.01].Thirteen RVD patients received low-molecular-weight heparin anticoagulation combined with thrombolytic therapy,and 29 RVD patients took low-molecular-weight heparin anticoagulant therapy.The pulmonary artery systolic pressure(PASP) and tricuspid regurgitation pressure levels were higher in the thrombolytic therapy group than in the anticoagulant therapy group(t =2.894,2.518 and 1.957,P =0.004,0.015 and 0.026).The incidence of bleeding was higher in the thrombolytic therapy group than in the anticoagulant therapy group (23.1％ vs.10.3 ％,x2 =3.498,P =0.015).Conclusions The right ventricular dysfunction should be confirmed in APE patients with embolism involving proximal pulmonary artery or(and)presenting clinical symptoms or signs such as syncope and tachycardia.The anticoagulation therapy is effective and safe for elderly patients with normal blood pressure and right heart dysfunction without risks for further deterioration.%目的 分析血压正常伴右心功能不全(right ventricular dysfunction,RVD)的急性肺栓塞(acute pulmonary embolism,APE)老年患者的临床特点. 方法 回顾性分析,选取133例老年血压正常的APE患者,根据是否合并RVD分为RVD组42例和非RVD组91例,对两组老年患者临床症状和体征的发生率、肺动脉栓塞部位的发生率及溶栓治疗后临床指标、出血发生率进行比较.结果 RVD组和非RVD组患者晕厥[33.3％(14/42)比7.8％(7/91)]、P2亢进晕厥[45.2％(19/42)比25.3％(23/91)]、心动过速[40.5％(17/42)比20.9％(19/91)]、发绀[26.2％(11/42)比8.8％(8/91)]、颈静脉充盈[11.9％(5/42)比1.1％(1/91)]比较,差异有统计学意义(x2值分别为4.928、4.644、5.410、4.971、4.163,均P＜0.05).RVD组和非RVD组患者患近端肺动脉栓塞[25例(59.5％)比8例(8.8％)]和肺叶动脉栓塞[32例(76.2％)比47例(51.6％)]比较,差异有统计学意义(x2值分别为13.636、9.530,均P＜0.01).RVD组患者13例子低分子肝素抗凝配合溶栓治疗,29例予单纯低分子肝素抗凝治疗.治疗后溶栓患者的肺泡动脉氧分压、肺动脉收缩压、三尖瓣反流压差水平高于抗凝组(t值分别为2.894,2.518,1.957;P值为0.004,0.015,0.026);但其出血率亦更高,3例(23.1％)和3例(10.3％),差异有统计学意义(x2=3.498,P=0.015). 结论 应及时明确血栓累及近端肺动脉和(或)出现晕厥、心动过速等临床症状或体征的急性肺栓塞患者有无RVD,无恶化风险的血压正常伴RVD的急性肺栓塞老年患者抗凝治疗疗效较好,安全性高.
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