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目的探讨老年肺栓塞的临床特点和诊断方法,减少误诊率和漏诊率。方法回顾性分析我院确诊的60例老年(≥65岁)肺栓塞的高危因素、临床表现和辅助检查结果。结果老年肺栓塞的危险因素为下肢静脉血栓(DVT,33.3%)、手术外伤(25.0%)、长期卧床(23.3%)。呼吸困难为最常见症状(80.0%),96.7%患者临床症状缺乏特异性。螺旋CT肺动脉造影(CTPA)结果显示老年患者肺栓塞部位主要为右下叶肺动脉(38.9%)、右肺动脉(35.2%)和左下叶肺动脉(29.6%),53.7%的患者为多支血管受累。核素肺通气/灌注扫描(V/Q扫描)的阳性率为73.9%,CTPA的阳性率为65.2%,43.5%的患者V/Q扫描和CTPA均为阳性,二者联用的检出率为95.7%。结论老年肺栓塞表现为多处、主要血管受累,以右肺动脉和双下叶肺动脉多见。提高老年肺栓塞的诊断水平,及时正确的诊断和治疗可改善预后,降低病死率。推荐联合使用V/Q扫描和CTPA检查。
Objective To investigate the clinical features and diagnostic methods of senile pulmonary embolism to reduce the misdiagnosis rate and misdiagnosis rate. Methods Retrospective analysis of 60 elderly patients (≥ 65 years old) diagnosed in our hospital risk factors, clinical manifestations and auxiliary examination results. Results The risk factors for senile pulmonary embolism were venous thrombosis of the lower extremities (DVT, 33.3%), surgical trauma (25.0%) and prolonged bed rest (23.3%). Dyspnea was the most common symptom (80.0%), and clinical symptoms were not specific in 96.7% of patients. Spiral CT pulmonary angiography (CTPA) showed that the pulmonary embolism in the elderly patients mainly consisted of right lower lobe pulmonary artery (38.9%), right pulmonary artery (35.2%) and left lower lobe pulmonary artery (29.6%), and multivessel involvement in 53.7%. The positive rate of radionuclide / perfusion scan (V / Q scan) was 73.9%, the positive rate of CTPA was 65.2%, and the positive rate of V / Q scan and CTPA was 43.5% 95.7%. Conclusion Elderly pulmonary embolism is manifested in many places, the main blood vessels involved, the right pulmonary artery and double lower lobes pulmonary artery more common. Improve the diagnosis of pulmonary embolism in the elderly, timely and correct diagnosis and treatment can improve the prognosis and reduce mortality. It is recommended to use V / Q scan and CTPA together.