| Pulmonary thromboembolism (PTE), or the so-called 'pulmonary embolism', refers to the series of clinical syndromes due to occlusion of emblems in the pulmonary artery system. PTE is a common sort of pulmonary vascular disease, with the incidence rate of about 0.5% in the western countries each year. In the United States, PTE ranks the third place in the cardiovascular diseases, with the incidence rate only lower than coronary heart disease and hypertension. Each year there are 0.2 million people who die of PTE. In clinics, PTE is also the third disease that leads to death, with the incidence inferior to malignant tumors and myocardial infarction. In the developing countries, there are 30 to 60 million people who die of PTE-DVT every year. As a result, PTE is regarded as an important issue for medical care.Although there were no exact epidemiological data on PTE in our country, it was estimated that the incidence rate of PTE is higher than that of the United States, as there are a huge amount of population and high incidence of venous thromboembolism, such as venous thromboembolism of the lower extremities. Moreover, anti-coagulant or thrombolytic therapies may now be undertreated. It has been demonstrated by the study of'regular diagnosis and treatment on pulmonary thromboembolism'(the 10th Five Year National Key Program for Science and Technology Development), which was finished during 2002 and 2005 in 50 domestic hospitals, that PTE is a common sort of disease in our country as well as in the United States.PTE is the sort of disease with acute onset and low specificity, with the major symptoms of syncope, hypotension or shock, chest pain or chest distress, tachypnea as well as fever, the rate of underdiagnosis or misdiagnosis remains high as a result. If not being alert, the patient may suffer from sudden death due to occlusion of giant emblem to the pulmonary artery.70% of the deaths tend to occur within the two hours after onset of PTE.Since 1970s, the concept of'health related quality of life'(HRQOL) have been introduced in the medical academy abroad. There were various quality-of-life scales used for evaluation on the therapeutic outcomes of different diseases. A lot of studies have been performed on the demographic and clinical characters and health-related quality of life in the disease-specific patients based on all those scales. However, few studies focused on their application in patients with pulmonary thromboembolism.The purpose of this study was to describe the major clinical manifestation during admission to the hospital and its variance after thrombolysis or anti-coagulant therapy through carrying out an observation in hospitalized patients with pulmonary thromboembolism. The common situations could be understood through a questionnaire investigation after recovery, and assessment was performed according to the MOS-36-item short form health survey (SF-36 scale), which is considered of high validity and efficacy worldwide. Quality of life during the third and eighth year after discharging from the hospital was also analyzed. All these may provide proofs for future health education and intervention approaches in patients with pulmonary thromboembolism. Objectives and methods:Data assessment and statistical analysis was performed on the clinical manifestation in 116 patients with physician-diagnosed pulmonary thromboembolism in the respiratory internal medicine department of Guangzhou Institute of Respiratory Disease during 2003 and 2008. And telephone investigation was carried out in 58 patients on post-recovery quality of life according to the inclusion criteria. The content of the survey included the common situation of the population and the assessment via the scale for quality-of-life investigation (SF-16 scale). The database was established on Excel, an electronic table for data analysis. The common situation was described and analysis was performed on the quality-of-life assessment as well as the impacts on quality of life through SPSS.Results:1. Among 116 patients with PTE, there were 81 male (69.9%) and 35 female (30.1%) patients, respectively. Four patients (3.4%) aged between 11 and 20, ten patients (8.6%) aged between 21 and 30, fifteen patients (12.9%) aged between 31 and 40, seventeen patients (14.7%) aged between 41 and 50, twenty patients (17.3%) aged between 51 and 60, twenty-six patients (22.4%) aged between 61 and 70, twenty-one patients (18.1%) aged between 71 and 80, and three patients (2.6%) aged over 80, respectively. The average age of all subjects was 54.96, with the mean of 50.62 in male and 65.0 in female. With regard to the patients enrolled in the study, the age of onset of PTE focused almost between 50 and 70. It was demonstrated that the senile patients were more liable to have PTE in the distribution spectrum of age, as the proportion was significantly higher in patients aged over 60.2. From the perspective of all sorts of risk factors,58 cases (50.0%) were. thrombolytic phlebitis,13 cases (11.2%) were chronic obstructive pulmonary disease (COPD), and 10 cases (8.6%) of each were coronary heart disease and trauma/surgery, respectively.9 cases (7.8%) were malignant tumors,7 cases (6.1%) were diabetes mellitus,5 cases (4.3%) were due to drug administration, and 4 cases (3.4%) were of no significant predisposing factor. Among 116 patients with PTE,112 cases (96.6%) had no less than one risk factors,51 cases (44.0%) had no less than 2 risk factors, and 12 cases (10.3%) had no less than 3 risk factors. A senile trend was demonstrated in all patients with PTE by statistics:the number of risk factors accumulated as the age became larger, and PTE was more liable to occur when multiple risk factors accumulated or superimposed.3. Various combinations of symptoms appeared in different cases of PTE, which were of low specificity. From the perspective of patients with PTE in our study, 86.2% experienced post-exercising tachypnea, which was also the most common symptom of all, followed by coughing, chest pain, difficulty in breathing at rest, palpitation and hemoptysis, etc. Most symptoms were relieved after thrombolytic or anti-coagulant therapies, while there were a number of patients with persisted post-exercising tachypnea and coughing, which accounted for 20.7% and 23.3%, respectively.4. The quality of life in patients with PTE was listed as follows:①No statistical significance was found in both gender and marriage from the survey of quality of life.②There was statistical significance noticed in the impact of the degree of education on physical health, the function of somatic and emotional role, and mental health, respectively. (F was 3.670,7.231 and 4.959, respectively. P was 0.019,0.001 and 0.005, respectively.)③There was statistical significance noticed in the impact of occupation on the function of somatic and emotional role, and mental health, respectively. (F was 4.295,3.078 and 3.489, respectively. P was 0.010,0.037 and0.023, respectively)④There was statistical significance of age status on the function of physical health,somatic role and emotional role,. (F was 4.106,3.0(?) and 6.962, respectively. P was 0.004,0.019 and0.001, respectively)⑤The degree of recovery of respiratory sounds was positively correlated to the score of the function of somatic role, and both the acceleration of heart rate and recovery of panic disorder were positively correlated to the physical energy after the therapy. The score of physical energy was lower in patients with syncope and hypotension. Patients with lower blood pressure scored less in their emotional role, which implied worse quality oflife.Conclusions:1) It is imperative to understand all the risk factors of pulmonary thromboembolism and carry out early nursing observation and intervention, which could save the precious time for treatments and reduce the death rate.2) The overall assessment of quality-of-life scale on patients recovered from PTE may provide comprehensive understandings on the physiologic, mental and social functional status. The assessment is targeted at the patients themselves, which tended to reflect the real function of both the disease and the therapy to the patients.3) While performing nursing on patients with PTE, it is necessary to enhance their understanding of the disease itself, reduce the impact of the risk factors, stress of both the psychic and mental recovery, help establish the healthy way of life and social supportive system so that the patients could treat the disease properly, eliminate negative moods and cooperate with the doctors well, thereby reducing the development and progression of the complications and elevate their quality of life.
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