| Objective:To explore and analyze the clinical characteristics,relative risk factors,auxiliary examination,therapy and prognosis of hospitalized patients with pulmonary embolism.Methods:Retrospective analysis was conducted for 193 patients diagnosed as pulmonary embolism in The First Affiliated Hospital of Medical College,Shihezi University from January 1,2007 to December 31,2016.Results:1.General situation: 87 male patients(45.1%),106 female patients(54.9%),with average age of 62.0±12.9.The departments was distributed widely,internal medicine departments are mainly distributed in pneumology department(32.1%),Department of Cardiology(18.7%),Department of Critical Care Medicine(8.8%);surgery departments are mainly distributed in orthopedics department(6.2%),general surgery department(5.7%),gynecology department(2.6%).The hospital diagnosed that morbidity has been increasing.During this ten years,nosocomial diagnostic general morbidity was 0.038%,0.033% for male,0.044% for female.The mortality rate of pulmonary embolism is relatively high,with the annual mortality rate of pulmonary embolism of 3.8%~20% and the general mortality rate of 4.1% which was diagnosed in the hospital during the ten years.2.The main clinical manifestations included dyspnea(151 patients,78.2%),thoracodynia(bosom frowsty)(19 patients,40.4%),fever(9.8%),palpitation(18 patients,9.3%),cough(expectoration)(36 patients,18.7%),symptoms of cerebral circulation insufficiency(16 patients,8.3%);triad of dyspnea,cough and hemoptysis(6 patients,3.1%).3.The main relative risks factors included aging(125 patients,64.8%),infection(79 patients,40.9%),hypertension(69 patients,35.8%),lied in bed for more than 3 days(31 patients,16.1%),diabetes(29patients,15.0%),varicose vein of lower limb(20 patients,10.4%),apoplexy paralysis(5 patients,2.6%).4.Auxiliary examination: D-dimer increase(183 patients,97.3%,183/188).Arterial blood gas analysis:I-type respiratory failure(58 patients,34.5%,58/168),II-type respiratory failure(8 patients,4.8%,8/168),hyoxemia(63 patients,37.5%,63/168),hypocapnia(78 patients,46.4%,78/168).Color doppler ultrasonography of heart: pulmonary arterial hypertension(37 patients,23.0%,37/161),right atrium or right ventricle enlargement(25 patients,15.5%,25/161).Color doppler ultrasonography of the lower limb vein: deep venous thrombosis(38 patients,31.4%,38/121),phlebothrombosis(8 patients,6.6%,8/121).ECG: T wave inversion in the precordial leads(38 patients,20.3%,38/187),tachycardia(33 patients,17.6%,33/187),SIQⅢTⅢ(23 patients,12.3%,23/187),right bundle branch block、 right axis deviation、clockwise rotation(20 patients,10.7%,20/187).Pulmonary artery CT angiography showed that 185 patients were diagnosed as pulmonary embolism,8 patients were clinically comprehensively diagnosed.5.Treatment and prognosis: alteplase was used in 9 patients for intravenous thrombolysis(4.8%),wherein6 patients continued to be treated with anticoagulant therapy after thrombolysis,and other 3 patients were not treated by the anticoagulant.163 patients(84.5%)were administered with oral anticoagulants.Wherein153 patients(79.3%)received warfarin,10 patients(5.2%)received rivaroxaban.After treatment,16 patients discharged automatically,8 patients died,the rest discharged after being better.There were 2patients who suffered from bleeding during hospitalization.Wherein 1 patient with lung cancer suffered from bleeding after receiving low molecular heparin for anticoagulation.And 1 patient died of bleeding after thrombolysis.Conclusions:1.The number of patients and morbidity of acute pulmonary embolism diagnosed in the hospital showed a trend of increase,with relatively high death rate and mortality without apparent trend of declination.There is no significant difference for morbidity between male and female patients.2.Departments for occurrence of acute pulmonary embolism distributed widely,the internal medicine departments are governed by respiratory medicine department and department of cardiology,and surgery departments are governed by orthopedics department,general surgery department and gynaecology and obstetrics department.3.The main relative risk factors of pulmonary embolism include aging,infection,hypertension,lying in bed for more than 3 days,diabetes and varicose vein of the lower limb.4.The symptom of pulmonary embolism is lack of specificity,mainly characterized by clinically dyspnea,thoracodynia(bosom frowsty),fever,palpitation,cough(expectoration)and insufficiency of cerebral blood supply.5.D-dimer with arterial blood gas analysis can be used as a simple method to screen pulmonary embolism;pulmonary artery CT angiography acts as main diagnosis basis.6.The effect of standardized anticoagulant therapy in patients with acute pulmonary embolism is good and the risk of bleeding is low.Presently the common oral anticoagulation is still warfarin,and some new oral anticoagulants have started to be used in the clinic;the risk of bleeding for thrombolytic therapy maybe relatively high,Further discussion on large sample data is needed. |
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