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目的提高对肺血栓栓塞症(PTE)诊断与治疗的认识。方法经肺动脉造影,放射性核素肺扫描和超声心动图等方法,对确诊的16例PTE进行回顾性分析。结果首诊误诊率87·5%(14/16),有深静脉血栓形成占56.2%(9/16),突发活动后气促占81.2%(13/16),肺梗死三联症6.25%(1/16)。本组病死率31.2%(5/16),未治疗组病死率100%(4/4),治疗组11.1%(1/9),溶栓联合抗凝治疗好转率100%(5/5),单纯抗凝治疗好转率75%(3/4)。结论PTE是一种极易误诊的疾病,深静脉血栓形成是导致PTE的重要因素,突发原因不明的呼吸困难,超声心动图提示右室后负荷增加者,伴低氧血症与过度通气是诊断PTE的重要线索,及时溶栓加抗凝治疗可显著降低病死率。
Objective To improve the diagnosis and treatment of pulmonary thromboembolism (PTE). Methods Sixteen patients with PTE confirmed by pulmonary angiography, radionuclide scan and echocardiography were retrospectively analyzed. Results The first misdiagnosis rate was 87.5% (14/16), deep venous thrombosis was 56.2% (9/16), postprandial breath was 81.2% (13/16), pulmonary infarction triad was 6.25% (1/16). The mortality was 31.2% (5/16) in the untreated group, 100% (4/4) in the untreated group, 11.1% (1/9) in the untreated group, 100% (5/5) in the thrombolysis plus anticoagulant therapy group, , 75% improvement in simple anticoagulant therapy (3/4). Conclusions PTE is an extremely misdiagnosed disease. Deep venous thrombosis is an important factor leading to PTE, unexplained dyspnea. Echocardiography suggests that the right ventricular afterload increase is associated with hypoxemia and hyperventilation. Important clues to diagnose PTE, timely thrombolysis plus anticoagulant therapy can significantly reduce the mortality.