Analysis On Diagnosis Of Acute Pulmonary Thromboembolism In316Cases

Objective: To analyze the clinical characteristics and diagnostic process of acute pulmonary thromboembolism(PTE), in order to reduce the missed diagnosticand misdiagnostic rate.Methods: Clinical data of316cases with acute PTE in our hospital from January2003to October2011were collected,with their general information, risk factors, clinical features, auxiliary examinamtion, the first visited department anddiagnostic time analyzed.Results: A number of inpatients with acute PTE are growing year by year.Age≥60years in192cases (60.76%), lower extremity deep vein thrombosis history in101cases (31.96%),96cases of coronary heart disease (30.38%),83cases of hypertension (26.27%), the recent history of operation in52cases (16.46%). Clinical manifestations of acute PTE are of diversity and without specificity,including dyspnea is most common,257cases (81.34%), chest distress32.28%, chest pain24.37%, cough21.52%, syncope18.04%, haemoptysis3.16%, among them experienced combination of dyspnoea, chest pain and haemoptysis only in9cases (2.85%). D-dimer>500ug/L in222(85.06%), D-dimer <500ug/L in39cases (14.94%); Electrocardiogram showed SⅠQⅢTⅢ in only8cases (3.62%);Through the lung ventilation/perfusion (V/Q) scan diagnosed as acute PTE in255cases (80.70%) and spiral CT pulmonary angiography (CTPA) diagnosed in58cases (18.35%). The first choice of most departments in emergency department,134cases (42.41%), followed by the Department of respiration130cases (41.14%) and cardiovascular department of internal medicine40cases (12.66%), theremaining12patients were distributed in8departments. The average diagnostic time of all316cases was44.57±53.52hours, and in the department of respiratory diseases the average diagnostic time was31.45±48.05hours, emergency room was45.52±53.84hours and cardiovascular medicine department was64.60±42.84hours. The diagnostic time in respiratory department was siginficantly shorter than that in emergency department and in cardiovascular medicine department (p<0.05).Conclusion:1. The incidence of acute PTE tends to increase yearly,and age is the most common risk factors.2. Clinical manifestations of acute PTE are complicated and non-specific.3. D-dimer is the most important screening method of acute PTE, and thelung V/Q scan and CTPA are the common methods to diagnosis PTE.4. Its first visited departments are mainly include respiratory medicine, emergency department and cardiovascular internal medicine. The diagnostic time in respiratory department was siginficantly shorter than that in emergency departmentand in cardiovascular medicine department, but those departments diagnostic timeare shorter than the other departments. So improving the understanding of the first visited department and strengthening the training work of the main departments, can effectively improve diagnostic level of acute PTE.