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目的探讨急性肺栓塞的早期诊断和治疗措施。方法通过对2003～2005年急诊明确诊断的24例肺栓塞患者的易发因素、临床表现、实验室检查及治疗转归进行临床分析。结果肺栓塞早期缺乏临床特异性表现,易漏诊、误诊,甚至突发猝死。血气分析有低氧血症者占100%,D-二聚体大于0.5 mg/L者占83.3%,超声心动图呈典型改变者占66.7%,胸片呈典型肺不张楔型改变者占33.3%,放射性核素扫描提示至少一个肺段灌注缺损并与通气不匹配者占83.3%。结论床旁心电图、血气分析、D-二聚体、超声心动图检查及胸片可作为急性肺栓塞的初筛检查;对于血液动力不稳定的急性肺栓塞,床旁快速无创检查可明确诊断,采用急诊快速溶栓治疗,可提高此类患者的生存率。
Objective To investigate the early diagnosis and treatment of acute pulmonary embolism. Methods The clinical data, clinical manifestations, laboratory tests and treatment outcomes of 24 PE patients with definite diagnosis from 2003 to 2005 were analyzed. Results Early lack of clinical manifestations of pulmonary embolism, easy to missed diagnosis, misdiagnosis, and sudden sudden death. Blood gas analysis of hypoxemia accounted for 100%, D-dimer greater than 0.5 mg / L accounted for 83.3%, echocardiography showed a typical change accounted for 66.7%, chest radiographs of typical atelectasis wedge type accounted for 33.3%. The radionuclide scan showed at least one pulmonary perfusion defect and 83.3% mismatched with ventilation. Conclusion bedside ECG, blood gas analysis, D-dimer, echocardiography and chest X-ray can be used as a preliminary screening of acute pulmonary embolism; for hemodynamic instability of acute pulmonary embolism, bedside rapid noninvasive examination can confirm the diagnosis, The use of emergency thrombolytic therapy can improve the survival rate of such patients.