| Objective: This study focuses on the clinical features of the normotensive acute pulmonary embolism patients with right ventricular dysfunction and those without. By analyzing the differences between them, it may improve the diagnosis and treatment level of normotensive acute pulmonary embolism patients with right ventricular dysfunction.Method: We enrolled 168 patients who were diagnosed acute pulmonary embolism with normal blood pressure in First Affiliated Hospital of Henan University of Science and Technology from January 2010 to December 2013 in which contains 100 males and 68 females, and their average age was 64.0±11.6 years. In accordance with the diagnostic criteria in the《Guidelines of the diagnosis and treatment of pulmonary thromboembolism》made by Chinese Medical Association of Respiratory branch, among the patients with pulmonary embolism dignosed by the 64 row spiral CT pulmonary angiography, the enrolled patients were divided into two groups according to the echocardiography results: the normal blood pressure with RVD group contained 100 males and 40 females, and their average age was 66.8±9.3years. The normal blood pressure without RVD group contained 36 males and 32 females, and their average age was 62.5±13.6years. We made comparative analysis of gender, age, medical history,clinical features and the related auxiliary examinations between the two groups. The RVD group is also divided into thrombolysis group and anticoagulation group, making comparative analysis between short-term effects and clinical outcomes after 6 months of treatment.Statistical analysis: the data was analyzed by SPSS 17.0. Measurement data was presented by mean±standard deviations, and the count data was presented by rate or constituent ratio. Chi-square, t test were used to analyze the data. P<0.05 has statistically significant difference.ResultThese two groups had no statistically significant difference in gender, age and medical history. While, chest pain, dyspnea, cyanosis, syncope, engorgement of the jugular veins, the respiratory rate, S2 accentuation, heart rate, pericardial and/or pleural effusion, blood gas analysis, BNP and electrocardiogram abnormality had statistically significant difference between these two groups(P<0.05). Among the RVD group, 29 patients were treated by thrombolytic therapy and subsequently anticoagulant therapy, as thrombolytic therapy group. 39 patients were treated only by anticoagulant therapy, as anticoagulant therapy group. Compared with anticoagulant therapy group, the clinical index of thrombolytic therapy group, such as alveolar-arterial oxygen tension difference, pulmonary arterial systolic pressure, was significantly improved. Compared with anticoagulant therapy group, the smaller hemorrhage risk of thrombolytic therapy group was significantly high, two groups had no life-threatening bleeding. While, the outcome after 6 monthes(chronic pulmonary heart disease and pulmonary arterial hypertension) had statistically significant difference between these two groups(P<0.05), Recurrence of pulmonary embolism and death had no statistically significant difference.Conclusion:Acute pulmonary embolism patients have clinical manifestation of dyspnea, cyanosis, syncope, tachycardia, P2 accentuation, engorgement of the jugular veins and electrocardiogram abnormality declared right ventricular pressure load increasement, should make echocardiography and BNP tests as soon as possible in order to make patients condition assessment and risk stratification. As the right ventricular involvement conditions of middle-risk group pulmonary embolism patients are different, disease severity and prognosis are also different. Whether to give thrombolysis treatment or not should consider the following two aspects:(1) whether the patients condition of the middle-risk group worsened, whether there is a serious right cardiac insufficiency, severe dyspnea, large area of myocardial damage; whether a new hemodynamics appears;(2) whether the bleeding risk is much too big. |
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