The Retrospective Analysis Of The Diagnostic Process And Clinical Status Of Pulmonary Embolism

Background:Pulmonary embolism (PE) is a serious complication due to occlusion of pulmonary artery and its branches caused by various embolus. PE has the "three high and one low" phenomenon which are high morbidity, high mortality, high rates of misdiagnosis, and a low rate of diagnosis. PE is one of the dieases which is harmful to human health. In the United States PE is the third common cardiovascular disease which is second to stroke and myocardial infarction. Pulmonary embolism mortality is very high, the main causes of death are the right heart failure, hypotension, cardiogenic shock, recurrent pulmonary embolism and acute or chronic pulmonary hypertension. Early and accurate diagnosis of this condition is imperative because many patients die within hours of presentation. How to improve the early diagnosis and reduce misdiagnosis or missed diagnosis is the problem faced by domestic and overseas clinicians currently. Then, this study focuses on the analysis of age of onset, risk factors, diagnosis measures, clinical symptoms, misdiagnosis reasons and the reasons of early hospitalized death which aims to improve the diagnosis of PE, reduce misdiagnosis or missed diagnosis and reduce mortality. The study program is as follows:Ⅰ.ObjectA retrospective chart review was conducted of 59 patients who were diagnosed PE in No.1 hospital of Jilin University from January 2001 to March 2008. There were 33 male (55.93%) and 26 female (44.07%), male/female= 1.27:1.0. The average age was (49.78±14.04) years old, range from 15 to 76 years old. The average age of male was (49.36±13.20) years old, and that of female was(50.31±15.29) years old.Ⅱ.MethodFirstly, we observe all the clinical datas of the PE patients including the age of onset, risk factors, clinical symptoms, diagnosis measures(the results of ECG, echocardiography, ultrasonography, D-dimer, blood gas analysis, CTPA, V/Q, lung CT and X-ray), confirmed measures, misdiagnosis; Secondly, all the patients were divided into two groups (survival group and death group) to compare the different factors( age, gender, heart disease, cerebrovascular disease, hypertension, varicose veins, phlebitis, surgical history, thrombosis, confirmed time, shock and right ventricular dysfunction ). SPSS11.5 software was used to analysis. Enumeration datas were expressed in percentage or a ratio. Chi-square test was used for enumeration datas. Measurement datas were expressed with mean±standard deviation(?X±S). Independent samples T-test was used for measurement datas. Multi-factor analysis used Enter method of Logic regression. P <0.05 was defined significant.Ⅲ.Result1.There was no significant difference on the age distribution of patients and no statistical difference on the age of onset between male and female.2.Postoperative, long-term bed rest, varicose veins of lower extremity, arteritis, cerebrovascular disease, thrombosis, and hypertension were main risk factors and basal diseases of PE.3.The symptoms of PE were complex and changeable, but dyspnea, chest pain, chest distress, cough and expectoration are the chief complaints.4.Of all diagnosis means,the D-dimer could rule-out PE,while echo- cardiography and Color Doppler ultrasonography of low limbs played an important role in diagnosis and differential diagnosis. The results of echo- cardiography were manifest augment of right heart , abnormal inter- ventricular septal motion, regurgitation of tricuspid valves>2.8 m/s and pulmonary hypertension. Thrombosis can be found directly when used on lower limb. Radionuclide lung ventilation/perfusion scan had high sensitivity, but low specificity. CT pulmonary angiography (CTPA) showed that multiple pulmonary embolism and the right lung were common. CTPA was the further inspections of confirming PE.5.There was a high rate of misdiagnosis on the initial visit, extral hospital misdiagnosis was 46.13% and our hospital misdiagnosis was 27.27%,The common misdiagnosis were myocardial infarction,heart failure,pneumonia and myocardiosis.6.Between the death group and survival group, the general situation (age, gender), basic disease (heart disease, cerebrovascular disease and hypertension), risk factors (varicose veins, phlebitis, thrombosis history and the history of surgery) and the confirmed time were not significantly different (P> 0.05). Right ventricular dysfunction was an independent risk factor of the PE early death(P=0.016,OR 4.759,95%CI 0.544～14.061).Ⅳ.The significance and inspiration of the study1.Risk factors can be found in vast majority of PE patients. Postoperative, long-term bed rest, varicose veins of lower extremity, arteritis, cerebrovascular disease, thrombosis, and hypertension are main risk factors and basal diseases of PE. It plays an important role in predict the possibility of PE before the test.2. Clinical symptoms of PE are complex and changeable, but dyspnea, chest pain, chest distress, cough and expectoration are the chief complaints. The risk factors combined with clinical symptoms can estimate the clinical possibility of PE which can reduce misdiagnosis and missed diagnosis.3. Although pulmonary angiography is the "gold standard" of confirming PE, but it is difficult to check as a conventional.Of all diagnosis means, the D-dimer can rule-out PE, while echocardiography and color Doppler ultrasonography of low limbs play an important role in diagnosis and differential diagnosis. CTPA is the preferred method of confirming PE. Clinic doctors need to diagnose the high-risk patients according to the procedure which is suspected consultation and comfirmed approach in order to improve early accurate diagnosis.4. The high rate of misdiagnosis of the initial visit of PE reflects that confusion between the myocardial infarction, heart failure, pneumonia and PE is common. It needs attention to remind clinicians of PE identification and heighten vigilance.5. Right ventricular dysfunction is an independent risk factor for PE death. Early to find evidence and reduce the incidence of right ventricular dysfunction is important to reduce mortality of PE.