急诊急性肺栓塞诊断的临床分析和探讨

杨惊; 朱华栋; 于学忠

doi:10.13201/j.issn.1009-5918.2016.08.021

急诊急性肺栓塞诊断的临床分析和探讨

- 中国医学科学院北京协和医学院北京协和医院急诊科(北京, 100000)

详细信息

通讯作者: 于学忠,E-mail:yxz@medmail.com.cn

中图分类号: R563.5

收稿日期: 2016-05-08

Clinical analysis on the diagnosis for emergency department patients with acute pulmonary embolism

- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100000, China

More Information

Corresponding author: YU Xuezhong, E-mail: yxz@medmail.com.cn

Received Date: 08 May 2016

摘要

摘要: 目的:探讨急诊就诊的急性肺栓塞的临床特点、危险因素与发病的关系,以提高急性肺栓塞的诊断准确性。方法:对2012~2015年115例急诊就诊的疑诊急性肺栓塞的病例进行回顾性分析,分为确诊急性肺栓塞患者组(68例)和疑诊肺栓塞后明确除外的患者组(47例),对2组的危险因素、临床症状、辅助检查进行对比分析。结果:胸痛、晕厥肺栓塞组均显著高于对照组(P<0.05),危险因素2组差异无统计学意义;临床检测指标中就诊时体温肺栓塞组低于对照组(P=0.03),血白细胞计数(P=0.04)、D-二聚体阳性率(P=0.01)肺栓塞组均显著高于对照组;就诊时Wells评分的ROC曲线优于改良Geneva评分。结论:胸痛和晕厥是急性肺栓塞的特异性临床表现,就诊时Wells评分对急性肺栓塞的预测可能优于Geneva评分。
- 肺栓塞 /
- 诊断 /
- Wells评分
Abstract: Objective:To investigate the relationship between the predisposing factors and onset of acute pulmonary embolism and to develop a simple and proper diagnostic strategy for emergency department patients with acute pulmonary embolism.Method:The predisposing factors,clinical prediction rules,clinical presentations of 115 patients with suspected acute pulmonary embolism (PE) were analyzed retrospectively.Result:There was no difference of predisposing factors and clinical presentations between PE group and the control group except the occurrence rate of chest pain and syncope.The occurrence of chest pain and syncope in PE group were significantly higher than that in the control group (P<0.05).Blood white cell count level and D-Dimer positive incidence in PE group were significantly higher than those in control group (P=0.04 and 0.01) but temperature was lower (P=0.03).The ROV curves of Wells score were better than revised Geneva score.Conclusion:Chest pain and syncope maybe the specific signs for acute pulmonary embolism.Wells score maybe better than revised Geneva score in assessment of clinical probability of acute pulmonary embolism.
- acute pulmonary embolism /
- diagnosis /
- wells score

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参考文献(16)

[1]	程璘令,吴华,何梦璋,等.不同年龄段患肺血栓栓塞症的危险因素及临床特征比较[J].中国实用内科杂志,2007,27(15):1187-1189.
[2]	中华医学会呼吸病学分会.肺血栓栓塞症的诊断与治疗指南(草案)[J].中华结核和呼吸杂志,2001,49(5):6-11.
[3]	Le G G,Righini M,Roy P M,et al.Prediction of pulmonary embolism in the emergency department:the revised Geneva score[J].Ann Intern Med,2006,144(3):165-171.
[4]	Wells P S,Anderson D R,Rodger M,et al.Derivation of a simple clinical model to categorize patients probability of pulmonary embolism:increasing the models utility with the SimpliRED D-dimer[J].Thromb Haemost,2000,83(3):416-420.
[5]	Heit J A.The epidemiology of venous thromboembolism in the community[J].Arterioscler Thromb Vasc Biol,2008,28(3):370-372.
[6]	Belohlavek J,Dytrych V,Linhart A.Pulmonary embolism,part I:Epidemiology,risk factors and risk stratification,pathophysiology,clinical presentation,diagnosis and nonthrombotic pulmonary embolism[J].Exp Clin Cardiol,2013,18(2):129-138.
[7]	Pollack C V,Schreiber D,Goldhaber S Z,et al.Clinical characteristics,management,and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department:initial report of EMPEROR(Multicenter Emergency Medicine Pulmonary Embol-ism in the Real World Registry)[J].J Am Coll Cardiol,2011,57(6):700-706.
[8]	Konstantinides S V,Torbicki A,Agnelli G,et al.2014ESC Guidelines on the diagnosis and management of acute pulmonary embolism[J].Eur Heart J,2015,36(39):2666-2666.
[9]	Penaloza A,Melot C,Motte S.Comparison of the Wells score with the simplified revised Geneva score for assessing pretest probability of pulmonary embolism[J].Thromb Res,2011,127(2):81-84.
[10]	Di M S,Cilia C,Campagna A,et al.Comparison of wells and revised geneva rule to assess pretest probability of pulmonary embolism in high-risk hospitalized elderly adults[J].J Am Geriatr Soc,2015,63(6):1091-1097.
[11]	Lucassen W,Geersing G J,Erkens P M,et al.Clinical decision rules for excluding pulmonary embolism:a meta-analysis[J].Ann Intern Med,2011,155(7):448-460.
[12]	Linkins L A,Bates S M,Lang E,et al.Selective D-dimer testing for diagnosis of a first suspected episode of deep venous thrombosis:a randomized trial[J].Ann Intern Med,2013,158(2):93-100.
[13]	van Belle A,Buller H R,Huisman M V,et al.Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability,Ddimer testing,and computed tomography[J].JAMA,2006,295(2):172-179.
[14]	Carrier M,Righini M,Djurabi R K,et al.VIDAS D-dimer in combination with clinical pre-test probability to rule out pulmonary embolism.A systematic review of management outcome studies[J].Thromb Haemost,2009,101(5):886-892.
[15]	Wells P S,Anderson D R,Rodger M,et al.Excluding pulmonary embolism at the bedside without diagnostic imaging:management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer[J].Ann Intern Med,2001,135(2):98-107.
[16]	Sharp A L,Vinson D R,Alamshaw F,et al.An ageadjusted d-dimer threshold for emergency department patients with suspected pulmonary embolus:accuracy and clinical implications[J].Ann Emerg Med,2016,67(2):249-257.