The Retrospect Analysis For Clinical Diagnosis And Treatment Of Pulmonary Embolism In Nearly Ten Years Of Chongqing City

Objective Pulmonary thromboembolism (PTE) is the most common type of pulmonary embolism (PE), accounting for ninety percent of PE. PE is used usually refer to PTE. The diagnosis and treatment status of pulmonary embolism in Chongqing has no relevant literature currently. This article investigated the diagnosis and treatment of pulmonary embolism in hospitals of different medical levels in recent 10 years in order to provide evidences to improve the level of the pulmonary embolism prevention, diagnosis and treatment.Methods 1. Samples from 31 hospitals in Chongqing (16 tertiary hospitals,15 second hospitals) by convenience sampling method were investigated. The investigation includes pulmonary embolism cases between 2003-2012, medical conditions, the consciousness of prevention and screening of pulmonary embolism.2. The clinical data of 336 pulmonary embolism patients from 31 hospitals of different medical levels of Chongqing from January 2003 to December 2012 by convenience sampling method were investigated. The questionnaire included:the general situation, the underlying diseases and risk factors, clinical manifestations, examination findings, treatment and prognosis.Results 1. Baseline investigation of Pulmonary embolism diagnosis and treatment:(1)The total number in nearly 10 years of pulmonary embolism diagnosis cases is 827 (636 cases were diagnosed in tertiary hospitals, accounting for 76.90%,191 cases were diagnosed in second hospitals, accounting for 23.10%). (2)With the time, pulmonary embolism diagnosis cases increased gradually, dramatically increased in 2009-2012. (3)Hospitals which can diagnose pulmonary embolism have increased year by year except 6 hospitals. (4) All of the investigated hospitals can carry out biochemical and imaging examinations such as D-dimer, blood gas analysis, Myocardial injury markers, APTT, INR and lower limb vascular ultrasound, cardiac ultrasound and enhancement CT. All the investigated hospitals have the essential medicines such as heparin, low molecular heparin, warfarin, urokinase. (5)17 hospitals can conduct CT pulmonary angiography (CTPA), including 9 hospitals for clinical diagnosis. (6)The 9 investigated hospitals conduct pulmonary embolism risk assessment with relevant scale table in some departments.2. Retrospective analysis of 336 cases of pulmonary embolism:(1) A total of 336 patients (195 cases were confirmed,141 cases were diagnosed in clinical) collected from 31 hospitals including 16 tertiary hospitals (n=316) and 15 second hospitals(n=19), of which 105 cases died. (2)The most common risk factors are hypertension, trauma and surgery, Lung cancer, cardiac insufficiency, malignant tumor, diabetes, braking, lung infection, coronary heart disease, rheumatic and COPD. (3)The common symptoms are dyspnea, symptoms of deepvein, chest pain, palpitation, cough, sputum, and syncope. (4)On ECG, the main changes are sinus tachycardia, V1-V6 T wave inversion or low or depression of ST segment, incomplete or complete right bundle branch block, atrial fibrillation, SI, Q?, T? and typical SIQ?T?. (5)On chest radiography, the main changes are regional pulmonary vascular texture fine, thinning, disappear, lung field increased transparency, lung shadow, pleural effusion, right ventricular dilatation. (6)The main changes of echocardiography are right atrial enlargement, right ventricular expansion, pulmonary arterial hypertension. (7)275 patients with D-dimer testing, accounting for 86.85%,of which 236 over 500ug/L. (8)The definite diagnose rate of un-elderly patients showed higher than that of elderly patients, the difference was significant (67.14% vs 51.03%, P=0.003); The mortality of elderly patients was higher than that of non-elderly patients, and the difference was significant (36.60% vs 24.29%, p=0.017). (9)The definite diagnose rate of patients who were diagnosed from 2008 to 2012 showed higher than patients who were diagnosed from 2003 to 2007, and the difference was significant (62.23% vs 38.6%, P?0.001); The mortality of patients who were diagnosed from 2003 to 2007 was higher than that of patients who were diagnosed from 2008 to 2012, and the difference was significant (49.12% vs 27.34%, p<0.001). (10)The definite diagnose rate of tertiary hospitals showed higher than that of second-class hospitals, and the difference was significant (59.81% vs 31.58%, P=0.015); The difference of the mortality of between tertiary hospitals and second-class hospitals was not significant (31.01% vs 36.84%,p=0.595). (11) the mortality of intervention group showed higher than non-intervention group, the difference was significant (14.53% vs 69.61%, p<0.001).Conclusions The consciousness of pulmonary embolism diagnosis was gradually improved for the most hospital medical staff from 2003 to 2012 in Chongqing, but the consciousness of prevention and screening high-risk patients with pulmonary embolism is poor. Tertiary hospitals mainly depend on enhanced CT pulmonary angiography (CTPA) in the diagnosis of pulmonary embolism. Pulmonary embolism diagnosis mainly conduct in clinic in different medical levels hospitals, and the definite diagnose rate is low. The diagnosis and treatment of Pulmonary embolism is non-standard, and the mortality of Pulmonary embolism is high. The ability of diagnosis and treatment of pulmonary embolism should be further improved.