Clinical Analysis Of The Patients With Pulmonary Embolism

Pulmonary embolism (pulmonary embolism, PE) is the clinical and pathophysiological circulatory disturbance syndrome that lung artery or its branch is blocked by endogenous or exogenous embolic. It is characteristic which pulmonary blood flow is obstructed。In the clinically,it main clinical situation are difficulty in breathing,shortness of breath,chest pain,hemoptysis,and so on。However, its clinical situation lack specificity of clinical disease。The patient who have the so-called typical PE signs such as hemoptysis, chest pain, triple breathing difficulty is parum [about 1 / 3], and is often misdiagnosed as other heart and lung diseases. In the United States, Pulmonary embolism is common diseases, which second only to cancer mortality and myocardial infarction, ranking third.[0],It is estimated that about 3O～60 million people suffer pulmonary embolism each year, a high mortality rate up to 30%. In the past, China was considered pulmonary embolism is a rare disease. Because of technical limitations, the lack of clinical manife stations'specificity, as well as the less cognition of pulmonary embolism, the detection rate was only about 20% to 30%. However, in recent years a series of autopsy'research confirmed that pulmonary embolism disease was not common in our country. The misdiagnosis rate was as high as 80% or even higher [1]. Pulmonary embolism can be fully recovered with timely therapy. Without timely therapy, mortality is 5 to 6 times the high of timely therapy, so the timely diagnosis and treatment are the key to solve the problem witch able to reduce the mortality rate of misdiagnosis, pulmonary angiography (digital subtraction angiography and DSA) has been considered as the gold standard of the Pulmonary Embolism's Diagnosis. The correct rate can be reach to 95%, but the inspection is invasive examination, it have a mortality rate (0.5%) and it also have a complications (6%) and blood vessel's overlap will limit the discover of peripheral pulmonary artery branches.[2-3], so the pulmonary angiography is not the first choice.However the V-P and CT imaging are the most commonly method in non-invasive inspection of PE. In recent years, with the continuous progress of CT technology, especially the spiral CT angiography (SCTA) has been widely used. Its characteristic are rapid imaging, displaying directly within the vascular emboli, high resolution, at the same time there may be other symptoms related to heart disease to the advantages of differential diagnosis. V-P imaging for diagnosis of PE have several decades of history. It can show the change in blood perfusion which by the pulmonary embolism caused. Its application is also common. Based on a group of patient's V-P and SCTA video imaging and data analysis, the aim of the text is further to confirm that these two methods of clinical value. At present treatment is commonly used thrombolysis and anticoagulation therapy, but there is still some patients because of thrombolysis and anticoagulation taboo or thrombolytic therapy and other medical treatment ineffective, surgery may be considered intervention and treatment, interventional therapy at home and abroad in recent years reported in the literature satisfied with the initial results, showing good prospects, high mortality treatment rarely used。This article first observed in January 2004 to March 2008 in our hospital patients with clinical suspicion of PE, combined history, signs, laboratory tests and imaging studies such as a clear diagnosis of 80 cases of PE in patients with the clinical data, included 44 men, 36 women, aged 23 to 74 years old, with an average age (47±5). Through this group of patients with the clinical data were analyzed retrospectively and specific statistics that various risk factors and the various clinical manifestations of the percentage, the positive rate of all kinds of inspections and checks of various features of each of the percentages, the initial diagnosis of misdiagnosis rate of the disease misdiagnosed as the percentage of what treatment programme, an efficient treatment, the cure rate and mortality. Secondly paper also randomly selected in January 2004 to March 2008 in our hospital and clinical suspicious final clinical diagnosis of PE has been ruled out of the 32 cases of PE (V-P imaging examination in 18 cases, 64 - MSCTPA checks 14 cases), also from the above PE of 80 cases randomly selected 40 cases (V-P imaging examination of 26 cases, 64 - MSCTPA checks 14 cases), these 72 patients were divided into two groups, group 1 (V-P Imaging Inspection Unit), 44 cases, 24 were male and 20 were female, with an average age of 48±5, group 2 (64 - MSCTPA Inspection Unit), 28 cases, 15 were male and 13 were female, with an average age of 47±6. Two groups with gender and age have no significant difference (P> 0.05). Standards to the final clinical diagnosis, calculated two check their sensitivity, specificity and accuracy. This paper also once again on 80 cases of patients with PE in 60 patients before and after treatment carry out a blood gas analysis, PaO2 and PaCO2 were calculated in before and after treatment, said the average measured to x±s.The results showed that: 80 cases (10cases in 2004,16 cases in 2005, 20 cases in 2006,28cases in 2007,6cases in 2008)of PE in 60 cases (75%) have deep venous thrombosis (DVT).Typical chest pain, hemoptysis, and dyspnea triple levy of only 10 cases (12.5%). D-dimer in 56 cases (93.3%) measured greater than 500 ng / ml.In arterial blood gas analysis of the 60 cases PaO2 <80mmHg of the 46 patients (76.7%), PaCO2 <35mmHg of the 52 patients (86.7%). ECG tests typical SI, QⅢ, TⅢperformance of the only eight cases (11.4%). Color Doppler detected 54 cases of heart in only 2 cases (3.7%) to see the last paragraph of pulmonary thrombosis. 60 routine chest radiography inspection, the positive in 44 cases (73.3%).65 cases of V-P phenomenon routine examination, 10 cases were non-deterministic diagnosis (15.4%), 55 cases (84.6%) were positive. 15 cases to 64 - MSCTPA examination, 15 cases (100%) were positive. Initial diagnosis of PE in 48 patients (60%), misdiagnosed as other diseases, 32 patients (40%). Clinical cure in 40 patients (50%), 32 patients (40%) improved clinical efficacy, indicating the two cases (2.5%), clinically dead six cases (7.5%).V-P imaging sensitivity, specificity, and accuracy were 91.3%, 76.2%, 84.1%, 64-slice spiral CT pulmonary angiography (64 - MSCTPA) were 100%, 64 - MSCTPA specificity and accuracy significantly higher than that of the V-P imaging examination (P <0.05), the sensitivity of the two inspection have no significant difference (P> 0.05). Before treatment PaO2 and PaCO2 of the average values were 8.65±1.73 and 3.72±0.80, after treatment PaO2 and PaCO2 of the average value was 10.64±1.86 and 4.92±0.93, PaO2 after treatment than before treatment PaCO2 and there have been noticeable improvements ( P <0.001).In this paper,the study of 80 cases have the following characteristics. Among the risk factors in PE, deep venous thrombosis is the most common. The presence of PE in patients with high risk factors, in particular the number of risk factors coexist, consideration should be given whether the disease. The clinical manifestations of PE is diversity but without the characteristic. The patients who have the typical chest pain, hemoptysis, and dyspnea triple levy is less than 1 / 3,so easily missed and misdiagnosed, therefore, the basis of the disease can not be explained by the chest tightness, shortness of breath, especially those with high risk factors exist, should be highly vigilant against the disease. Arterial blood gas analysis and D-dimer low specificity and high sensitivity can be used as reference and exclude for acute PE.ECG performance varied, the typical performance little more meaningful and dynamic observation. Color Doppler can detect cardiac thrombosis and evaluation of cardiac function,but its direct signs of emerging opportunities is very small and can not be diagnosed as the main checkpoint. Diagnosis can not rely on chest radiography inspection PE .V-P imaging and 64 - MSCTPA diagnosis of PE is the main method, as V-P imaging specificity weaker, the impact of other factors to blood flow, the more false-positive, should pay attention to the differential diagnosis, the sensitivity and specificity of 64 -- MSCTPA are high, can be used as the preferred inspection PE. Only rapid and correct diagnosis, and timely access to treatment areas, the diagnosis is one of the key links. Thrombolytic therapy and the role of anticoagulation therapy have different mechanism. Thrombolysis is rapidly dissolving blood clots, lift or reduce pulmonary obstruction, in order to improve hemodynamics and restore lung tissue reperfusion, pulmonary capillary increase the capacity and reduce pulmonary artery pressure, reversed right heart failure, and anticoagulant therapy can prevent thrombus formation by the machine in the role of fibrinolysis source in existence thrombosis narrow or dissolved, and can also prevent the formation of new thrombosis, although anticoagulant therapy can not directly reduce the mortality rate, but it can reduce deaths of thrombosis, and prevent embolism development recurrence, the two treatment methods can reduce mortality and improve the quality of life, combined with greater significance. Timely correct treatment of some patients can be cured, most can be noticeably improved, so the treatment is also one of the key links.To sum up, PE was the incidence of the development trend of increased year by year ;PE has many risk factors and the deep vein thrombosis is main risk factors;The clinical manifestations of PE is diversity but without the characteristic. The patients who have the typical chest pain, hemoptysis, and dyspnea triple levy is less than 1 / 3, so easily missed and misdiagnosed;Laboratory test for specificity is not high, so it is only as a reference standard diagnosis and exclusion criteria;Detection of specific imaging(chest radiography, heart color Doppler ultrasound, CT scan, etc.) is lower, so it can not be use as the main diagnostic methods of PE;At present the more reliable diagnostic method are V-P imaging and 64- MSCTPA. In the diagnosis, PE 64 - MSCTPA obviously superior V-P imaging, so it can be use as the clinical preferred method of diagnosis of PE;The most patients with the right treatment can be cured or significantly improved, very individual treatment is ineffective or clinically dead, timely correct diagnosis and treatment can reduce the mortality rates of patients and improve the quality of life.