Clinical Analysis Of Acute Pulmonary Embolism With Dimer Negative

Obsjective: To retrospectively analyze the clinical characteristics of the patients with D-dimer-negative acute pulmonary thromboembolism(PTE),and to explore the simplified Wells score,Daniel electrocardiogram score and arterial blood gas analysis results of those patients,so as to provide basis for the diagnosis of D-dimer-negative acute PTE,reduce missed diagnosis and misdiagnosis.Methods: The clinical data of 250 patients with acute PTE hospitalized in the First Affiliated Hospital of Guangxi Medical University from March 2016 to May 2018 were collected.500ug/L was taken as the demarcation line between positive and negative D-dimer.All patients were divided into D-dimer negative pulmonary embolism group(group A)or D-dimer positive pulmonary embolism group(group B).Forty patients with D-dimer negative non-severe pneumonia excluding pulmonary embolism were randomly selected as control group(group C).The results of simplified Wells score,Daniel electrocardiogram score and oxygen partial pressure(PO2),carbon dioxide partial pressure(PCO2)and pulse oxygen partial pressure difference(P(A-a)O2)in each group were compared.Resul: Among the 250 patients with PTE,24(9.6%)were D-dimer negative PTE.There were no significant differences between group A and group B in the percentage of simplified Wells score(>2),Daniel electrocardiogram score(>2),PO2,PaCO2,and P(A-a)O2.However,there were significant differences between group A and group C in the percentage of simplified Wells score(>2),Daniel electrocardiogram score(>2),and P(A-a)O2.Conclusion:1.The plasma D-dimer of some patients with acute PTE is less than 500 ug/l.2.Simplified Wells score,Daniel electrocardiogram score and arterial blood gas analysis examination have certain predictive value for DD-negative PTE.Especially when patients with deep venous thrombosis,heart rate ?100 times/minute,P(A-a)O2 > 20 mmHg,new Q-wave in lead III,even if DD is negative,they should be vigilant for PTE.If necessary,they should improve the examination as soon as possible and make a definite diagnosis so as to avoid missed diagnosis.