Clinical Features Of 29 Cases Of Pulmonary Embolism Were Analyzed

Objective:This study of 29 cases of imaging diagnosis of pulmonary embolism of young patients as the research object,from the risk factors,clinical signs and symptoms,diagnostic analysis from several aspects,and discuss the clinical characteristics,in order to help improve clinical understanding of young acute pulmonary embolism,provide clinical basis for early diagnosis and reduce misdiagnosis missed diagnosis.Method:Collected in August 2014 to July 2017 in the second affiliated hospital of nanchang university in hospitalized patients with pulmonary vascular enhancement(such as: lung CTA,CTV,DSA)confirmed,age range between the age of 20 to 40 of 29 cases of youth pulmonary embolism;Among them,18 were males and 11 were females,with an average age of 31.52(31.51 persons 6.8)years.Through the analysis of the risk factors,such as smoking,lower extremity deep vein thrombosis,pregnancy/puerperium,trauma/surgery history,etc.),clinical signs and symptoms(such as chest pain,hemoptysis,difficulty in breathing respiratory tract,lung appearance existing lower limb swelling,hypotension,cyanosis,etc.),laboratory test results(D-dimer,hypoxemia,elevated myocardial necrosis markers,etc.),auxiliary examination results(deep vein thrombosis of lower limb,tricuspid regurgitation,pulmonary hypertension,ecg changes,etc.),sum up the clinical characteristics of young patients with pulmonary embolism,and analyses the causes of misdiagnosis and misdiagnosis.Results:1.Youth pulmonary embolism in patients with common risk factors mainly include: 8 cases(28%),always smoking or found the VTE in 7 cases(24%),pregnancy/puerperium in 5 cases(17%),long-term sit down/lie in 5 cases(17%),in the near future has a history of trauma/fracture surgery in 5 cases(17%),4 cases were malignant tumor or chemotherapy(14%),nephrotic syndrome,3 cases(10%),3 cases of infectious diseases(10%),metabolic diseases,2 cases(7%),etc.,without any risk factors in 3 patients(10%).Among those at high risk of pulmonary embolism during pregnancy or puerperium,5 of 11 female patients had this risk factor,up to 45%.2.Respiratory symptoms or signs of 22 cases(76%),mainly include chest pain,hemoptysis,difficulty breathing,dry cough/breathing and lung's sound,but at the same time with chest pain/haemoptysis,breathing difficulties and other typical views on performance of patients 6 cases(21%);In addition,also found some extrapulmonary performance accounted for less than not,such as lower limb swelling(both combination of lower extremity deep vein thrombosis)14 cases(48%),11 cases(38%),fever,tachycardia,10 cases(34%),5 cases(17%),cyanosis,4 cases of hypotension(14%),palpitate palpitations in 3 patients(10%),fidgety/look/consciousness in 3 patients(10%),patients with asymptomatic 3 cases(10%),patients with no signs of 1 case(3%).3.The positive rate of plasma d-dimer was 86% in 25 cases.Other for lower extremity deep vein thrombosis in turn 17 cases(59%),hypoxemia,8 cases(28%),6 patients with elevated myocardial necrosis markers(21%),tricuspid regurgitation in 12 cases(41%),5 cases with pulmonary hypertension(17%),electrocardiogram(ecg)changes(pulmonary P wave,right bundle branch block,sinus arrhythmia)9 cases(31%),etc.4.Of the 29 cases,10 were confirmed at the time of admission or in the external hospital,and 6 were new during hospitalization;At the time of admission,13 cases(49%)were misdiagnosed or missed diagnosis,including 7 cases of pulmonary infection(54%),1 case of coronary heart disease,1 case of spontaneous pneumothorax,1 case of tuberculosis and 3 cases of missed diagnosis.Conclusions:1.Smoking rates were highest among young patients with pulmonary embolism,followed by those with deep vein thrombosis of lower limbs,pregnancy/puerperium,long-term sitting or bed rest,trauma/fracture/surgery history.Pregnancy is one of the most important risk factors for pulmonary embolism in young women.2.Youth pulmonary embolism in patients with respiratory performance is still higher than 76%,and the typical cases of views about 21%,there are cases of lower limb swelling often with lower extremity deep vein thrombosis,which in turn cause pulmonary embolism.3.Plasma d-dimer remains a sensitive indicator of pulmonary embolism,and the positive rate of tricuspid regurgitation under color ultrasound may be higher than pulmonary hypertension.Pulmonary embolism in young people is often misdiagnosed as pulmonary infection.