Wang Xiao-Fang, Lu Wei-Xuan, Li Guo, Shi Ju-Hong, Wang Chen
Department of Respiratory Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2010 Mar;33(3):206-9.
To explore the clinical characteristics of acute pulmonary thromboembolism (PTE) in elderly patients, in order to improve the diagnosis and treatment of the disease.
The clinical data were reviewed for patients aged over 60 years old hospitalized with acute PTE in Peking Union Medical College Hospital from January 2006 to January 2009.
The average age of the 68 patients was (72 +/- 6) years old. Deep vein thromboembolism was found in 33 cases. Hypertension (55.9%), cancer (32.4%), surgery (29.4%), immobility (29.4%), diabetes (23.5%) and obesity (20.6%) were the most common risk factors, with 70.6% (48/68) of these patients having more than 2 risk factors. The common symptoms were dyspnea (77.9%), cough (26.5%), chest pain (13.2%), palpitation (13.2%), faint (13.2%) and asymmetric edema of the lower extremities (30.9%). All of the arterial blood gas in 61 cases showed hypoxemia. The positive rate of blood D-dimer elevation was 84% (47/56). The main signs in chest X-ray were infiltrates (37.5%) and pleural effusions (18.8%). Non-specific ST-T changes (59.3%) and sinus tachycardia (23.7%) were the most common abnormalities in electrocardiogram. Forty seven cases (69.1%) were diagnosed through CT pulmonary angiography (CTPA), and 20 cases (29.4%) were through ventilation-perfusion lung scintigraphy. Sixty one cases received anticoagulant therapy and 5 received thrombolytic therapy. Vena cava filters were implanted in 5 patients. Fifty six cases improved after treatment, and the case fatality ratio was 18% (12/68).
The most common risk factors for PTE in elderly patients were chronic diseases, cancer, surgery and immobility. The symptoms and auxiliary examination of these patients were not specific, and CTPA was the most useful diagnosing tool. Anticoagulation was the basic treatment for PTE in elderly patients and it was safe and effective, while the overuse of thrombolytic therapy and vena cava filter should be avoided.
探讨老年急性肺血栓栓塞症（PTE）的临床特点，以提高该病的诊治水平。
回顾性分析2006年1月至2009年1月在北京协和医院住院治疗的60岁以上急性PTE患者的临床资料。
68例患者平均年龄为（72±6）岁。33例发现深静脉血栓形成。高血压（55.9%）、癌症（32.4%）、手术（29.4%）、制动（29.4%）糖尿病（23.5%）和肥胖（20.6%）是最常见的危险因素，70.6%（48/68）的患者有2种以上危险因素。常见症状为呼吸困难（77.9%）、咳嗽（26.5%）、胸痛（13.2%）、心悸（13.2%）、晕厥（13.2%）和下肢不对称水肿（30.9%）。61例患者动脉血气分析均显示低氧血症。血浆D-二聚体升高阳性率为84%（47/56）。胸部X线主要表现为肺部浸润影（37.5%）和胸腔积液（18.8%）。心电图最常见的异常为非特异性ST-T改变（59.3%）和窦性心动过速（23.7%）。47例（69.1%）通过CT肺动脉造影（CTPA）确诊，20例（29.4%）通过肺通气灌注显像确诊。61例接受抗凝治疗，5例接受溶栓治疗。5例患者植入了下腔静脉滤器。56例治疗后好转，病死率为18%（12/68）。
老年PTE最常见的危险因素为慢性疾病、癌症、手术和制动。这些患者的症状和辅助检查无特异性，CTPA是最有用的诊断工具。抗凝是老年PTE的基本治疗方法，安全有效，应避免过度使用溶栓治疗和下腔静脉滤器。
