| ObjectiveAs people's diet and lifestyle and living environment change, clinical diagnosis consciousness and diagnosis technology to continuously improve the level of domestic was diagnosed with pulmonary embolism was increased year by year, the incidence rate is increasing year by year, the clinical symptoms and signs of specificity, easily lead to misdiagnosis, delay the best treatment time the early clinical evaluation. The Wells score and modified Geneva scale score, but can only predict the possibility of pulmonary embolism, cannot become the basis of diagnosis; two Ddimer(D-Dimer, DD) in the plasma of healthy people in the DD content is little, and when the in vivo thrombin generation and secondary fibrinolysis activation the abnormal increase, is a sensitive indicator for microvascular thrombosis, but its specificity is low is often used for early screening of pulmonary embolism; with the rapid development and wide application of multi-slice spiral CT Technology The pulmonary artery, enhanced scanning with scanning speed, time resolution and other advantages, provides a convenient and rapid method for checking and diagnosis of pulmonary embolism diagnosis, the test of choice in clinic. This study review of the research analysis of the clinical data of patients with pulmonary embolism, and further analysis of the two D- dimer CT combined with pulmonary embolism index in the early diagnosis and treatment of pulmonary embolism in the guiding effect and value, so as to further the early diagnosis of pulmonary embolism and provide important reference for treatment. MethodsAccording to the Wells score and modified Geneva scale scores of clinical evaluation results all patients were divided into moderate and high risk groups, the two groups were collected in general, including gender, age, clinical symptoms and signs, risk factors, underlying diseases, treatment; at the same time in the group within 12 h D- two dimer pulmonary angiography and echocardiography, comparative analysis of two groups of patients before and after treatment of D- two level of D-dimer, CT pulmonary embolism index, echocardiographic indexes(heart rate, PVED/LVED, PASP, EDV, ESV, SV, LVEF, PER) level changes; in addition, compared two groups of patients with treatment effect and the prognosis of the patients. Results1?Pulmonary embolism in male and older than 50 years old among multiple, the main clinical symptoms were dyspnea, chest pain, cough, hemoptysis, main clinical signs as tachycardia, shortness of breath, pulmonary rales, lower extremity edema, jugular venous distention, clinical symptoms and signs of patients with multiple lung 91.04%. Embolism risk factors such as strong, weak and susceptible factors was only 8.96%; in addition, hypertension, diabetes, coronary heart disease and other diseases accounted for about 65.01%. and patients and high-risk patients in gender, age, clinical symptoms and signs, risk factors, the data underlying disease had no significant difference(P > 0.05).2 CT pulmonary angiography(CTPA) as the gold standard, two D- dimer was positive in 548 cases, the positive rate was 66.34%,The positive rate of 36.68% in the risk group was significantly lower than 82.31 in the high risk group(?2=175.2045, P=0.0000);This group of 826 patients, the average level of DD was 3085.56 ± 1025.38ug/L,The high-risk group mean DD level was 3128.36 + 1236.58ug/L was significantly higher than 2865.35 ± 1036.54ug/L in risk group(t=3.2462, P=0.0012);826 patients with an average value of CTI was 45.38 ± 8.69%,The high-risk group and the average CTI is 52.36± 10.38% higher than 30.58 + 5.64% in risk group(t=33.1295, P=0.0000)?3 Before and after treatment in patients with acute pulmonary embolism, heart rate, RVED/LVED, EDV, ESV were significantly higher than the average level of the normal population(P < 0.05),The LVEF and PER values were lower than the average level of the normal population(P < 0.05),While the SV value is In patients with acute pulmonary embolism after treatment, heart rate, LVEF, the level of PER was higher than before treatment(P < 0.05),In the risk groups increased more significantly higher degree of risk group(P < 0.05);RVED/LVED, PASP, EDV and ESV were significantly lower than before treatment(P < 0.05),In the risk group index decreased more significantly than high risk group(P < 0.05).4 In 826 patients, 309 cases of pure anticoagulation,517 cases of thrombolytic anticoagulant therapy,Selection of low molecular weight heparin calcium in 358 cases, and 305 cases of Shaaban, Shaaban, of 122 cases, 41 cases of warfarin,After treatment, the total effective rate was 73.97%,Thrombolytic therapy for patients with a total effective rate of 81.82% was significantly higher than 60.84% of pure anticoagulation therapy in patients with the total effective(?2=44.2004, P=0.0000).A total of 47 cases died, the mortality rate was 5.69%,Thrombolysis and anticoagulation treatment was 3.68% significantly lower than 9.06% Anticoagulantion mortality(?2=10.4568, P=0.0012).826 cases of patients with DD and CTI levels were significantly lower than before treatment(P < 0.05). Conclusion1 Pulmonary embolism in patients with no specific clinical symptoms and signs, for over 50 years and have strong risk factors such as to strengthen health education, systematic screening, prevent the occurrence and development of pulmonary embolism, reduce the incidence of pulmonary embolism from the root.2 Two D- dimer for pulmonary embolism screening an extremely sensitive index, and increased the level of pulmonary embolism more possibility of larger and more severe disease.CTPA as a non-invasive imaging, analysis and processing of the branch in the blood vessel and walking speed scanning and short postprocessing, the size and shape of thrombus, accurate positioning the stenosis degree of advantage is very significant, through the calculation of CT CTPA images of pulmonary embolism index number of pulmonary artery embolism and clear obstruction severity, clinical diagnosis of pulmonary embolism can be used as the preferred method of examination, combined with more early diagnosis.3 Pulmonary embolism treated with anticoagulation and thrombolytic therapy, but the efficacy is not ideal anticoagulant, thrombolytic therapy and anticoagulation therapy has good synergistic effect, combined treatment effect is more precise, and significantly reduce the mortality rate. At the same time, two D- dimer and CTI level changes monitored during therapy regularly, can provide true and reliable the basis for clinical treatment.4 Two D- dimer with CT pulmonary embolism index has important application value in clinical early diagnosis of pulmonary embolism and guide clinical treatment in the clinical application and spread. |
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