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目的 探讨肺栓塞的临床特征。方法 经病史采集 ,常规体格检查、胸部 X线片、心电图、超声心动图 ,最后经放射性核素肺灌注 /通气显像确定诊断。结果 2 8例患者中男 13例 ,女 15例 ,年龄 2 3～ 6 5岁 ,平均(4 4± 12 )岁。病程 1个月～ 3a。栓子来源有下肢深静脉血栓 11例 (占 39.3% ) ,胫腓骨骨折 2例 (占 7.1% )。临床表现有活动性呼吸困难 2 5例 ,心悸 13例 ,胸憋 12例 ,咯血 7例 ,晕厥 4例。体征有心率 >10 0次 / m in者 15例 ,心尖部及三尖瓣区收缩区杂音 10例 ,P2 亢进 2 0例 ,肺呼吸音减弱或部分消失 3例。辅助检查可见 X线显示肺动脉凸出 2 3例 ,右室大 10例 ,可发现肺部密度增高阴影仅 2例。心电图表现 S Q T 仅 6例 ,右室大 10例 ,TV1～ 4倒置 5例 ;超声心动图右室大 2 1例 ,右房大 17例 ,肺动脉高压 14例 ,心包积液 2例。本组病例中有 17例(6 7.9% )曾被误诊。结论 肺栓塞常有活动性呼吸困难 ,心悸 ;X线显示肺动脉凸出 ,超声心动图右室大 ,肺动脉高压应想到本病。放射性核素肺灌注 /通气显像和增强 CT扫描是确诊本病的重要手段。
Objective To investigate the clinical characteristics of pulmonary embolism. Methods The patients were diagnosed by medical history, routine physical examination, chest X-ray, electrocardiogram and echocardiography, and finally confirmed by radionuclide pulmonary perfusion / ventilation imaging. Results Among 28 patients, 13 were males and 15 were females, ranging in age from 23 to 65 years (mean age, 44 ± 12). Duration of 1 month ~ 3a. The source of emboli was deep vein thrombosis in 11 cases (39.3%) and tibiofibular fractures in 2 cases (7.1%). Clinical manifestations of active dyspnea 25 cases, palpitations in 13 cases, 12 cases of chest suppression, hemoptysis in 7 cases, 4 cases of syncope. Sign of heart rate> 10 0 times / m in 15 cases, apex and tricuspid valve systolic murmur in 10 cases, P2 hyperthyroidism 20 cases, lung breath sounds weakened or partially disappeared in 3 cases. Auxiliary examination showed X-ray showed pulmonary artery protrusion in 23 cases, 10 cases of right ventricle, can be found in the shadow of increased lung density in only 2 cases. The electrocardiogram showed only 6 cases of S Q T, 10 cases of right ventricle and 5 cases of inverted TV 1 ~ 4. There were 21 cases of right ventricular echocardiography, 17 cases of right atrium, 14 cases of pulmonary hypertension and 2 cases of pericardial effusion. Seventeen patients (6 7.9%) in this group had been misdiagnosed. Conclusions Pulmonary embolism often has active dyspnea and heart palpitations. X-ray shows pulmonary bulbar. Echocardiography should have right ventricular mass and pulmonary hypertension should be considered. Radionuclide lung perfusion / ventilation imaging and enhanced CT scan is an important means of diagnosis of the disease.