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目的探讨肺栓塞的临床特点及诊治。方法总结分析42例肺栓塞的临床资料。结果42例患者中呼吸困难42例(100%),紫绀25例(59.5%),肝大、双下肢水肿19例(45.2%),低血压10例(23.8%),胸痛、咳嗽、咯血5例(11.9%),P2>A234例(80.9%),发热。近期心电图呈现明显右心室负荷增加17例(40.5%),超声心动图示右房、室增大、右肺动脉增宽、压力增高34例(80.9%)。血气分析PaO2<60mmHg25例(59.5%)。B超探查下肢深静脉血栓形成24例(57.0%),15例和7例分别行CT、MRI检查,检出率均为100%。36例内科治疗,6例导管内溶栓治疗,治愈8例(19.0%),好转出院26例(61.9%),死亡8例(19.0%)。结论肺栓塞以劳累性呼吸困难、急性剧烈胸疼痛为主要症状,心脏及大血管彩超、CT、MRI有助于明确诊断。本病病死率高,以有效的内科治疗为基础,及时采取溶栓或介入治疗是降低死亡率的有效办法。
Objective To investigate the clinical features and diagnosis and treatment of pulmonary embolism. Methods The clinical data of 42 cases of pulmonary embolism were analyzed. Results 42 cases of dyspnea were found in 42 cases (100%), cyanosis in 25 cases (59.5%), hepatomegaly, edema in both lower extremities in 19 cases (45.2%), hypotension in 10 cases (23.8%), chest pain, cough and hemoptysis Cases (11.9%), P2> A234 cases (80.9%), fever. Recent ECG showed obvious right ventricular load increased in 17 cases (40.5%), echocardiography showed right atrium, ventricular enlargement, right pulmonary artery widening, pressure increased in 34 cases (80.9%). Blood gas analysis PaO2 <60mmHg 25 cases (59.5%). 24 cases (57.0%) had deep venous thrombosis by B-mode ultrasonography, and CT and MRI were performed in 15 cases and 7 cases respectively. The detection rate was 100%. 36 cases were treated by internal medicine and 6 cases were treated by intraductal thrombolysis. Among them, 8 cases were cured (19.0%), 26 cases were improved (61.9%) and 8 died (19.0%). Conclusions Pulmonary embolism is mainly due to exertional dyspnea and severe chest pain. Cardiac and macrovascular ultrasonography, CT and MRI are helpful to confirm the diagnosis. The high mortality of this disease, based on effective medical treatment, timely thrombolysis or intervention is an effective way to reduce mortality.