| Objective: To summarize the clinical date of 137 cases diagnosed as pulmonary thromboembolism(PTE)by CT pulmonary angiography(CTPA),to explore the predisposing factors,clinical symptoms and signs,auxiliary examination and diagnosis and treatment of PTE,to improve the level of diagnosis and treatment of the disease,so as to reduce missed diagnosis,misdiagnosis and mortality.Methods:The clinical date of 137 PTE patients diagnosed by CTPA in all department of our hospital and Luzhou municipal People,s Hospital and Luzhou Hospital of Traditional Chinese Medicine from January 2015 to October 2017 were retrospective collected.Induce factors,clinical symptoms and signs,auxiliary examination and diagnosis and treatment of other information summarized and statistical analysis.Results: 1.Among 137 patients with PTE,82(59.9%)were male and 55(4 0.1%)were female,with an average age of 62.35 ± 9.57 years,of whom 78(56.9%)were over 60 years of age and 40 to 60 There were 36 patients(26.3%),23 patients(16.8%)<40 years old.2.The vast majority of patients there have clear predisposing factors.The most common predisposing factors were deep venous thrombosis of the lower extremities(75.8%),followed by advanced age(60.9%),smoking(52.3%),chronic lung disease(46.1%),surgery(44.5%)and so on.In deep venous thrombosis of the lower extremity,the most common site of thrombosis were the calf myenteric vein(69.1%).In the Department of orth opedics surgery accounted for the largest proportion(61.4%),the most comon fractures were lower limb fractures(52.3%).3.The most common symptoms of PTE were shortness of breath/dyspnea(79.6%),followed by cough(60.6%),heart tiredness(49.6%),chest pain(33.6%),hemoptysis(23.4%)and so on.There were only 9 patients(6.6%)with chest pain,hemoptysis and dyspnea.The most common signs were rapid breathing(78.8%),followed by tachycardia(66.4%),pulmonary rales(48.9%),filling of the jugular vein(32.8%),cyanosis of the lips(24.1%)and so on.34 patients with signs of DVT(24.8%).4.Results of the Clinical examinations: 1)Plasma D-dimer: D-dimer of all the 137 patients:128 cases were positive and 9 cases were negative,all the high-risk patients were positive.2)Arterial blood gas analysis: 126 patients underwent this examination,of which 74 cases of hypoxemia,hypocapnia in 55 cases,hypoxemia and hypocapnia in 24 cases,normal 21 cases.3)Myocardial injury markers(monitoring cTNI and BNP): 129 patients underwent this examination,with 59 cases of elevated cTNI and 71 cases of elevated BNP and normal 10 cases.4)Electrocardiogram of all the 137 patients: The most common was sinus tachycardia,86 cases complete / incomplete right bundle branch block in 51 cases,ST-T changes in 48 cases,atrial fibrillation in 17 cases,only 6 cases of SIQIIITIII,normal 31 cases.5)Echocardiography examination of 124 patients: 83 cases of pulmonary hypertension(> 30mmHg),61 cases of tricuspid regurgitation,right heart increased 45 cases.6)Lower extremity vascular ultrasound: 137 patients underwent this examination,of which 97 cases of deep vein thrombosis.7)CTPA: 137 patients underwent this examination,including 7 cases of pulmonary artery embolism,49 cases of right pulmonary artery embolism,30 cases of left pulmonary artery trunk embolism,and 81 cases of single / multiple lobe and segmental pulmonary artery branch embolism.5.The situation of diagnosis and treatment and complications: In the high-risk group of 9 cases,8 cases were given thrombolytic therapy and anticoagulation therapy.One case of skin mucosal hemorrhage occurred in the course of treatment,and 1 case was discharged due to their own reasons.There were 90 cases in the intermediate risk group,of which one cases were given thrombolytic therapy and anticoagulation therapy.There were no complications during the treatment.89 cases received simple anticoagulation therapy,skin mucosal hemorrhage occurred in 2 patients,occult occult blood in 2 patients(1 patient stopped using anticoagulant drug due to bloody stool),and 1 patient had gum bleeding.In the low-risk group,38 patients were given anticoagulant anticoagulation alone.Two cases of mucocutaneous bleeding occurred during the course of treatment.Conclusions: 1.The incidence of PTE gradually increased with age.2.The vast majority of patients there is a clear predisposing factors,common predisposing factors followed by deep vein thrombosis,advan ced age,smoking,chronic lung disease,surgery.3.PTE clinical manife stations of diversity,routine examination such as ECG,arterial blood gas,echocardiogr aphy,etc.also lack specificity.The diagnosis of PTE mainly dep ended on CTPA.4.The treatment of PTE requires rapid and accurate stratification of the patient's risk,and then develop a reasonable treatment plan according to the condition of the disease.5.PTE anticoagulant therapy is a long process which required long-term follow-up. |
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