Analysis of clinical characteristics of 50 cases of acute pulmonary embolism with syncope as the first symptom
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摘要: 目的 探讨以晕厥为首发症状的急性肺栓塞患者临床特点，提高临床诊治效率。方法 回顾性分析2020年4月-2023年4月于济宁医学院附属医院确诊的50例以突发晕厥为首发症状的急性肺栓塞患者临床资料。包括性别、发病年龄、基础疾病、临床症状、实验室检查(血气分析、血浆D-二聚体、脑利钠肽、肌钙蛋白等)、心电图、超声心动图、下肢静脉彩超、肺动脉CT造影检查、肺栓塞严重指数、肺栓塞危险分层等指标。结果 50例患者中，男19例(38%)，女31例(62%)；平均发病年龄为(67.4±8.5)岁；起病时间0.5~264.0 h，中位时间6.5(3.75，24.00) h；有基础疾病者43例(86%)；所有患者均以晕厥起病(100%)，伴有呼吸困难(36例，72%)、胸痛(10例，20%)、头晕(13例，26%)、呕吐(7例，14%)、肢体抽搐(6例，12%)等非特异性症状；血气分析低氧血症者32例(64%)；血浆D-二聚体平均值为(9.54±7.1)mg/mL；心电图提示心动过速者35例(70%)；超声心动图检查存在右心扩大者30例(60%)，其中右心房测量平均值为(42.7±3.6) mm，右心室测量平均值为(41.8±4.6)mm，肺动脉高压者38例(76%)；双下肢静脉彩超提示血栓存在者40例(80%)；肺动脉CT造影检查均提示肺动脉充盈缺损，中央型45例(90%)，周围型5例(10%)。肺栓塞严重程度指数≥Ⅲ级者46例(92%)，肺栓塞危险分层中-高危者45例(90%)，50例患者入院后均及时抗凝治疗，8例患者(16%)接受了阿替普酶溶栓，13例患者(26%)进行了下腔静脉滤器置入治疗。48例(96%)患者均好转出院并继续口服抗凝治疗，1例患者自动出院后失访，1例患者死亡。结论 以晕厥为首发症状的急性肺栓塞患者具有高龄、起病迅速、缺乏典型症状、临床危险分层级别高的特点，及时筛检出高危性晕厥患者并进行急性肺栓塞的诊断和风险评估至关重要。急诊明确诊断并给予有效抗凝治疗预后良好。Abstract: Objective To investigate the clinical characteristics of acute pulmonary embolism patients with syncope as the first symptom, so as to improve the efficiency of clinical diagnosis.Methods The clinical data of 50 patients with acute pulmonary embolism diagnosed with sudden syncope as the first symptom in the Affiliated Hospital of Jining Medical University from April 2020 to April 2023 were retrospectively analyzed. Including gender, age of onset, underlying diseases, clinical symptoms, laboratory tests(blood gas analysis, plasma D-dimer, brain natriuretic peptide, troponin, etc.), electrocardiogram, echocardiography, lower limb venous color ultrasound, pulmonary artery CTA, pulmonary embolism severity index, risk stratification of pulmonary embolism, etc.Results Among the 50 patients, 19 were male(38%) and 31 were female(62%). The mean age of onset was (67.4±8.5) years old, the onset time was 0.5-264.0 hours, and the mean onset time was 6.5(3.75, 24.00)hours. There were 43 cases(86%) with underlying diseases. All patients started with syncope (100%), accompanied by dyspnea(36 cases, 72%), chest pain(10 cases, 20%), dizziness(13 cases, 26%), vomiting(7 cases, 14%), limb convulsions(6 cases, 12%) and other nonspecific symptoms. Blood gas analysis showed 32 cases(64%) of hypoxemia. Mean plasma D-dimer(9.54±7.1) mg/mL; Electrocardiogram indicated tachycardia in 35 cases(70%). There were 30 cases(60%) with right ventricular enlargement by echocardiography, of which the mean value of right atrial and right ventricular measurements was (42.7±3.6) mm, (41.8±4.6) mm and 38 cases(76%) with pulmonary hypertension. In 40 cases(80%), venous ultrasonography of both lower limbs indicated thrombus. Pulmonary artery CTA all indicated pulmonary artery filling defect in 45 cases(90%) of central type and 5 cases(10%) of peripheral type. There were 46 patients(92%) with grade Ⅲ pulmonary embolism severity index, 45 patients(90%) with medium-high risk stratification of pulmonary embolism risk, 50 patients with timely anticoagulation treatment after admission, 8 patients(16%) received alteplase thrombolysis, and 13 patients(26%) underwent inferior vena cava filter placement. Forty-eight patients(96%) were discharged with improvement and continued oral anticoagulant therapy, one patient was lost to follow-up after automatic discharge, and one patient died.Conclusion Acute pulmonary embolism patients with syncope as the first symptom are characterized by advanced age, rapid onset, lack of typical symptoms, and high clinical risk stratification. It is of great significance for timely screening of high-risk syncope patients, as well as diagnosis and risk assessment of acute pulmonary embolism. Good prognosis may be found in patients with clear emergency diagnosis and effective anticoagulation treatment.
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[1] Kasturi S. Current concepts in the diagnosis and management of pulmonary embolism[J]. Int J Clin Med, 2021, 12(3): 115-129. doi: 10.4236/ijcm.2021.123013
[2] 贾卫红, 杨栋才, 李楠, 等. 以短暂性意识丧失为主要症状成人急性肺血栓栓塞症误诊分析及文献复习[J]. 临床误诊误治, 2022, 35(10): 4-6.
[3] 吴孝林. 肺动脉栓塞诊断中64排螺旋CT肺动脉成像的应用及临床意义分析[J]. 现代医用影像学, 2022, 31(3): 485-488.
[4] Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology[J]. Europ Heart J, 2020, 41(4): 543-603. doi: 10.1093/eurheartj/ehz405
[5] 沈世茉, 周莹艳, 吴仕波, 等. 以晕厥为首发表现的肺栓塞患者肺栓塞严重指数及预后分析[J]. 浙江中西医结合杂志, 2018, 28(12): 1042-1044.
[6] 中华医学会呼吸病学分会肺栓塞与肺血管病学组, 中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会, 全国肺栓塞与肺血管病防治协作组. 肺血栓栓塞症诊治与预防指南[J]. 中华医学杂志, 2018, 98(14): 1060-1087.
[7] 贾卫红, 祝阿妮. 非手术、非制动超高龄患者多发肺栓塞的误诊分析[J]. 临床误诊误治, 2022, 35(4): 1-5.
[8] 中华医学会心血管病学分会, 中国医师协会心血管内科医师分会肺血管疾病学组, 中国肺栓塞救治团队(PERT)联盟. 急性肺栓塞多学科团队救治中国专家共识[J]. 中华心血管病杂志, 2022, 50(1): 25-35.
[9] 张丽梅, 周文华, 王芳芳, 等. 急性肺栓塞延迟诊断原因分析及应对策略[J]. 现代实用医学, 2022, 34(11): 1424-1426.
[10] 侬会秘, 鞠川, 王伟, 等. 以反复晕厥为表现的肺栓塞1例并文献复习[J]. 当代医学, 2021, 27(29): 176-177.
[11] Barbero E, Bikdeli B, Chiluiza D, et al. Performance of early prognostic assessment independently predicts the outcomes in patients with acute pulmonary embolism[J]. Thromb Haem, 2018, 118(04): 798-800.
[12] 关晴, 余陆娇, 张海燕, 等. 老年患者静脉血栓栓塞症的临床特点及预后分析[J]. 中华老年心脑血管病杂志, 2023, 25(4): 386-389.
[13] Lee YH, Cha SI, Shin KM, et al. Clinical relevance of syncope in patients with pulmonary embolism[J]. Thromb Res, 2018, 164: 85-89.
[14] 闭春萍, 张毅, 赵立, 等. 急性肺栓塞晕厥和不良预后关系的研究[J]. 中国心血管杂志, 2018, 23(6): 454-458.
[15] 李佩佩, 马耿, 齐娜, 等. 老年中、高危肺栓塞肺动脉压力变化趋势及其与预后的相关性[J]. 中国老年学杂志, 2022, 42(16): 3947-3950.
[16] 邓晴, 张忠满, 朱轶, 等. 老年肺栓塞并发晕厥患者的临床特征分析[J]. 南京医科大学学报(自然科学版), 2020, 40(7): 1045-1049.
[17] 和雪改, 毛毅敏, 何俊. 肺栓塞伴发晕厥危险因素的非条件logistic回归分析[J]. 实用医学杂志, 2017, 33(4): 558-560.
[18] 王洪宝, 孙桂娟, 张波. 首发症状不典型肺栓塞8例临床报道及文献复习[J]. 中国民间疗法, 2023, 31(14): 104-107.
[19] 钟建利, 王学文, 徐承义, 等. 急性肺栓塞患者并发晕厥症状危险因素及预后的相关研究[J]. 心肺血管病杂志, 2022, 41(12): 1242-1247.
[20] 李敏, 许伟, 陈艳, 等. 晕厥联合cTNT、PESI评分在209例急性肺栓塞患者中的临床分析[J]. 临床肺科杂志, 2020, 25(12): 1800-1804.
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