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目的探讨如何提高对老年人肺栓塞的诊断率和减少漏诊率。方法对50例确诊的老年急性肺栓塞患者的易患因素、临床特点、辅助检查、治疗方法及转归进行临床评估分析。结果50例肺栓塞患者中,主要临床表现为呼吸困难者为92％、咳嗽为56％、心悸为50％、胸痛为46％;血气分析示低氧血症者占94％;D-二聚体>500μg／L者占90％;螺旋CT肺动脉造影(CTPA)为主要诊断方法;接受溶栓治疗19例,单纯抗凝治疗29例,2例因出血未行任何抗凝治疗。17例行下腔静脉滤器植入术以预防再次肺栓塞。治愈5例(均为溶栓患者),占10％;好转43例,占86％;死亡2例(均为单纯抗凝治疗患者),占4％。结论肺栓塞临床表现多样;X线胸片、心电图等常规检查不具特异性;D-二聚体具有筛选价值;CTPA是首选的诊断方法,必要时可以做核素肺通气灌注显像和肺动脉造影;老年肺栓塞患者溶栓治疗时出血风险较高。
Objective To explore how to improve the diagnosis of pulmonary embolism in the elderly and reduce the rate of missed diagnosis. Methods 50 patients with confirmed acute pulmonary embolism in patients with predisposing factors, clinical features, laboratory examinations, treatment methods and outcome of clinical evaluation analysis. Results Among the 50 patients with pulmonary embolism, the main clinical manifestations were dyspnea with 92%, cough with 56%, palpitations with 50% and chest pain with 46%, blood gas analysis with hypoxemia (94%), D-dimer Body> 500μg / L accounted for 90%; spiral CT pulmonary angiography (CTPA) as the main diagnostic method; received thrombolytic therapy in 19 cases, anticoagulant therapy in 29 cases, 2 cases of bleeding without any anticoagulant therapy. 17 cases of inferior vena cava filter implantation to prevent re-pulmonary embolism. 5 cases were cured (all thrombolytic patients), accounting for 10%; improvement in 43 cases, accounting for 86%; 2 died (both patients with anticoagulant therapy), accounting for 4%. Conclusions The clinical manifestations of pulmonary embolism are diverse. The routine examination such as X-ray and electrocardiogram is not specific. D-dimer has screening value. CTPA is the first choice for diagnosis. Nuclide pulmonary perfusion imaging and pulmonary angiography ; Elderly pulmonary embolism patients with higher risk of bleeding when thrombolytic therapy.