Clinical Analysis Of 176 Cases Which Diagnosed Pulmonary Thromboembolism

Objective:To analyze the clinical characteristics of 176 pulmonary thromboembolism(PTE) patients of The Second Hospital of Jilin University and discuss the risk factors, clinical symptoms, indexes of screening and diagnosing at an early stage, the best treatment and the value of age-adjusted D-dimer cut-off in diagnosing PTE of elderly patients in our hospital.Methods:We disposed and analyzed the clinical data of 176 cases of PTE collected in our department from 2010 to 2014, including the general information, risk factors, clinical symptoms, examination and treatment, and collected the D-dimer data of patients which Age≥50 years old and suspected PTE but have been excluded this disease after CTPA examination and then calculated the sensitivity, specificity, positive predictive value and negative predictive value and Youden index of the two groups of traditional and the age-adjusted D-dimer cut-off standard, compared the sensitivity and specificity of whether there are differences.Results:1. Among the 176 patients were 91 male(51.7%) and 85 female(48.3%), 126 patients older than 50(71.6%). Their ages ranged from 23 to 84 and average age was 66.2±10.4.2. There were 137 patients with risk factors(77.8% of the diagnosed patients) and 39 patients without any certain risk factors(22.1% of the diagnosed patients). 55 patients had surgeries or traumatic bone injuries(47 patients with traumatic bone injuries of the legs). 62 patients had concave edema or superficial vein expansion of lower limb. 17 patients were diagnosed with tumor. 35 patients smoke. 5 patients were obese. 3 patients were diagnosed with nephritic syndrome. 1 patient took contraceptive drugs for a long period.1 patient had long-term oral contraceptives. 1 patient had the surgery of diagnosed anti-phospholipid antibody syndrome. 1 patient had post operation of congenital pulmonary artery stricture. 1 patient had systemic lupus erythematosus.3. These Patients had the following clinical manifestations: 45 patients coughed with blood; 88 patients had chest pain; 152 patients breathed with difficulty and shortness of breath. 2 patients fainted; 19 patients were hit by shock caused by low blood pressure. 16 patients had typical chest pain, hemoptysis, dyspnea triad.(9.1% of the diagnosed patients).4. Results of the Clinical examinations:1) Echocardiography examination of 135 patients: Rright ventricular enlargement: 27 cases; Increased pulmonary artery pressure: 31 cases; tricuspid regurgitation: 9 cases; decreased right ventricular wall motion amplitude: 7 cases.2) Lower limb venous ultrasound: 163 patients completed the examination and lower extremity venous thrombosis were confirmed in 123 cases(29 cases of both sides,59 cases of the left side, 35 cases of right side).3) CTPA of 176 patients: main pulmonary artery embolization: 7 cases; left and right main pulmonary artery embolization: 30 cases; right pulmonary artery trunk embolism: 43 cases; left pulmonary artery trunk embolism: 31 cases; The single or multiple lobes、segments and sub segments pulmonary artery embolism: 65 cases; 19 cases with Pleural effusion and 58 cases with pneumonia.4) Electrocardiogram of all the 176 patients: sinus tachycardia: 63 cases; V1-V4 T wave inversion and abnormal ST segment 17 cases; typical SⅠQⅢTⅢ changes: 5 cases; fast atrial fibrillation 8 cases; completeness right bundle branch block: 13 cases. However, normal electrocardiogram: 70 cases.5) Blood gas analysis of all the 176 patients: 67 cases presented hypoxemia(containing respiratory failure type I in 35 cases), 74 cases were normal.6) D-dimer of all the 176 patients: 174 cases were positive and 2 cases were negative.7) Monitoring myocardial injury markers(CK-MB) of 126 patients: 24 cases were abnormal.5. According to the traditional D-dimer cut-off standard, among the 393 patients(older than 50) were 328 positive cases and 65 negative cases, including 119 cases of true positive and 58 cases of true negative. According to the age-adjusted D-dimer cut-off standard, there were 316 positive cases and 77 negative cases, including 117 cases of true positive and 68 cases of true negative. The sensitivity, specificity, positive predictive value, negative predictive value and Youden index were 94.44%, 21.72%, 36.28%, 89.23%, 0.16 of the group of traditional D-dimer cut-off standard and 92.86%, 25.47%, 37.03%, 88.31%, 0.18 of the group of age-adjusted D-dimer cut-off standard. No significant difference in sensitivity and specificity between the two group(P>0.05).6. 74 patients completed thrombolysis and anticoagulation therapy(13 cases were gave 2 hours therapy option, 61 cases were gave 12 hours option, urokinase was used in thrombolysis therapy). Adverse reactions for example fever, allergies, hypotension, nausea, vomiting, headache and muscle pain were not found for all the patients. None of the patients in thrombolytic and anticoagulant therapy had fatal bleeding. 89 patients who had contraindications were not suitable for thrombolysis treatment, they were given anticoagulation therapy with warfarin and low molecular heparin, and 13 patients were only given low molecular heparin anticoagulant therapy. 3 of the 176 patients dead in PTE group. Other patients continued to be treated with the anticoagulant therapy after discharge.7. All patients were followed up after leaving hospital and there were no patients with bleeding or death, of which there were three patients with recurrent PTE and hospitalized again, the others are in good condition.Conclusions:1. The incidence of PTE increases progressively with age.2. Most patients with PTE have relevant disease and risk factors.3. Due to the occult clinical manifestations of PTE require diagnosing at an early stage a variety of other laboratory examinations, D-dimer and CTPA are gold standard of screening and diagnosing.4. For the PTE patients accompanied with hemodynamic instability, if there was no absolute contraindication, should be timely thrombolytic therapy. For intermediate-risk PTE patients, they could be treated by low-dose thrombolytic therapy or anticoagulant therapy after the comprehensive evaluation.5. Good long-term anticoagulation work would have important impact on patients’ prognosis.