综合内科142例老年人肺栓塞临床特点#

摘要

目的：总结老年肺栓塞住院病人的临床特点以及抗凝治疗前后D-二聚体的变化。方法：选择我院收治的肺栓塞患者256例，观察组分为老年组142例，非老年组114例，比较临床表现和危险因素差异，同时观察抗凝治疗后血浆D-二聚体含量的变化。并选取健康对照组200例，采用多元Logistic回归模型分析老年人肺栓塞危险因素。结果：观察2组呼吸困难、咳嗽、胸闷的患病率分别是85.2%和81.6%，72.5%和71.1%，57%和62.3%，两组比较无统计学差异，但非老年组咯血的患病率（27.2%），高于老年组（9.9%），差异有统计学意义（P＝0.000）；老年组无症状（12.7%）多于非老年组（2.6%），有统计学意义（P＝0.004）。老年组的危险因素多见于糖尿病、高血压、慢性阻塞肺疾病和既往脑卒中。抗凝治疗后，两组患者D-二聚体均较治疗前明显降低，差异有统计学意义。老年组的独立危险因素分别为COPD、既往深静脉血栓病史、恶性肿瘤和既往脑卒中；非老年组为既往深静脉血栓史。结论：老年人急性肺栓塞的临床表现多不典型，现呼吸困难仍为最常见的临床表现。COPD、恶性肿瘤、既往深静脉血栓和脑卒中均为老年人急性肺栓塞的独立危险因素，需注意加以鉴别。%Objective: To summarize the clinical feature and risk factors of patients suffering from pulmonary embolism(PE) in the elderly patients,and explore the change of D-dimer after anticoagulant therapy.Methods:256 patients with suspected PE were admitted from January 2009 to May 2015 in the Cangzhou Central Hospital,acomparison of clinical features and risk factors,between the elderly groups and non-elderly.The change of D-dimer content was determined before and 3-day after anticoagulant therapy in two groups.Results:The most important risk factor for the elderly patients was stroke.but for non-elderly patients was DVT.After anticoagulant therapy,the decreasing level of D-dimer was significant statistical differences in two groups. Conclusion:Between the elderly and non-elderly groups,the main clinical manifestations were similar.The main symptoms is dyspnea.The risk factors of elderly patients is COPD, therioma, DVT and stroke.After anticoagulant therapy,the content of D-dimer is lower than 3-day ago.D-dimer test is a good screening test for PE. (P<0.05).