Clinical Analysis Of Massive/Sub-massive Pulmonary Embolism And Non-massive Pulmonary Embolism

Objective To raise diagnosis of consciousness of different severity of PTE, by discusses clinical characteristics of large/major area of pulmonary embolism and non-massive pulmonary embolism.Methods From September 2008 to February 2010 in department of Respiratory Medicine, First Affiliated Hospital of Shanxi Medical University, clinical data of 68 patients already diagnosed with pulmonary embolism are divided into large or major area of group (A group,33 cases) and non-large area of group (B group,35 cases) based on 2001 Chinese Society of Respiratory Diseases credits will be diagnosis and treatment of pulmonary embolism Guide (draft).Clinical data of two groups were analyzed. PTE were compared risk factors, symptoms, signs and laboratory examinations.Results1.68 cases of PTE were 41 males (60.3%) and 27 females (39.7%), age from 28 to 75, mean age (57.9±15.2) years. A group of 33 patients of which 23 males (69.7%) and 10 females (30.3%), age from 35 to 71, mean age (58.1±15) years of age; B group of 35 patients,18 males (51.4%) and 17 females (48.6%), aged 28 to 75 years, mean age (57.7±15) years of age, two groups of gender, age, the difference was not statistically significant (P> 0.05).2. Comparison of risk factors of the two groups showed differences in the incidence of cerebral infarction was significant (P<0.05), the other two groups were no statistically significant difference (P> 0.05).3. Comparison of clinical findings, lower blood pressure than the usual basis of blood pressure, syncope, cyanosis, P2 hyperthyroidism,respiratory rate faster, pulse, and obvious difficulty in breathing (Borg score) difference was significant (P<0.05).4. Difference of positive D-Dimer test was significant between the two groups (P<0.05). The blood gas analysis for the PTE is PaO2 decline and low PaCO2, or respiratory alkalosis. Low PaCO2 in the assessment of the severity of PTE was significantly(P<0.05). Incidence rate of non-specific ST-T ECG change is 67.6%. Between the two groups based on non-specific ST-T ECG changes difference was significant (P<0.05).The difference of echocardiography indicators which amplitude of the right ventricle wall motion (RVAWM) is weakened, and right/ left ventricular diameter ratio (RVTD/LVTD) is abnormal (ratio> 0.6), and tricuspid regurgitation pressure gradient (TRPG) was significantly (P<0.05). Difference of CTPA between the two groups was not significant (P> 0.05). When PTE coexistence lower limb DVT, the lower extremity vascular ultrasound found that the direct signs of thrombosis in the left lower extremity was higher than in the right lower limb. Between the two groups based on lower extremity vascular ultrasound examination revealed direct signs of thrombosis difference was significant (P<0.05).Conclusion1. Lower blood pressure than the usual basis of blood pressure, syncopte, cyanosis, P2 hyperthyroidism, respiratory rate faster, pulse, Borg score, Positive D-Dimer test,Non-specific ST-T ECG changes, RVAWM, RVTD/LVTD, TRPG and lower extremity vascular ultrasound examination revealed direct signs of thrombosis can be used as indicators to judge the severity of PTE.2. When PTE risk assessment, in addition to pay attention to dyspnoea and other common symptoms and signs, it should also pay attention to changes around the right heart function and lower limb DVT in a series of clinical indicators. Combination of symptoms, signs, laboratory examinations and many other indicators of risk stratification and prognosis may be the future trend of PTE.