Du Jie-fu, Lei Yong-hong, Yang Guang, Meng Qing-yi, Shen Hong
Emergency Medicine Department, General Hospital of Chinese PLA, Beijing 100853, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2011 May;23(5):309-12.
To evaluate the correlation of pulmonary embolism (PE) and original diseases by retrospectively analysis of the patients for 20 years in single medical center.
Five hundred and five patients with PE were admitted and treated in General Hospital of Chinese PLA from January 1989 to January 2009, and their clinical data were retrospectively reviewed to analyze the risk factors of PE and the correlations of PE with the original diseases.
Of the 505 patients with PE in the past 20 years, the incidence of PE was increased year by year, especially it increased spectacularly after the year of 2004 [61.2% (309) vs. 38.8% (196)]. It was found to be most prevalent in patients of 4160 years old. Its incidence in males was 1.52 folds higher than that of the females [60.4% (305) vs. 39.6% (200)]. Dyspnea, chest pain and hemoptysis were the initial symptoms in the PE patients. Among the 505 patients, 40.0% of them complained dyspnea with chest pain and hemoptysis. Among them, dyspnea occurred in 100.0% of patients, hemoptysis in 52.1%, and chest pain in 40.0%. In 31.1% of the patients if was complicated with deep venous thrombosis (DVT), 19.8% of them suffering from varicosity, 9.5% of them had the history of surgery less than 30 days before, 22.0% of them suffering from neoplasm, 3.6% of them were accompanied with cerebrovascular disease within 4 days, 17.4% of them were accompanied with infection, 10.1% of them were accompanied with primary pulmonary hypertension, and 16.8% of them were accompanied with heart diseases. Multivariate analysis showed that the history of surgery, DVT and neoplasm had significant correlation with the occurrence of PE [odds ratio (95% confidence interval), OR (95%CI) was 4.540 (2.186-9.443), 0.325 (0.155-0.682), 2.610 (1.020-6.708), P<0.05 or P<0.01], while oral contraception, primary pulmonary hypertension and cerebrovascular disease showed a less significant correlation with the occurrence of PE [OR (95%CI) was 0.297 (0.078-1.126), 3.210 (0.855-12.110), 2.939 (0.862-10.020), all P>0.05]. The age and infection did not show significant correlation with the occurrence of PE [OR (95%CI) was 1.041 (0.674-1.607) and 0.820 (0.410-1.665), both P>0.05].
The PE is difficult in diagnosis, but with increasing cognizance, the diagnostic rate of PE has been increased. Patients with history of surgical operation, DVT or neoplasm, who complain dyspnea without known cause, chest pain or hemoptysis, should be subjected to further examinations, as to confirm the diagnosis of PE, then the survival rate of the patients with PE may be elevated.
通过对单一医学中心20年患者的回顾性分析，评估肺栓塞（PE）与原发病的相关性。
回顾性分析1989年1月至2009年1月在中国人民解放军总医院收治并治疗的505例PE患者的临床资料，分析PE的危险因素以及PE与原发病的相关性。
在过去20年的505例PE患者中，PE的发病率逐年上升，尤其是在2004年后显著增加[61.2%（309例）对38.8%（196例）]。发现其在41 - 60岁患者中最为常见。男性发病率比女性高1.52倍[60.4%（305例）对39.6%（200例）]。呼吸困难、胸痛和咯血是PE患者的初始症状。在505例患者中，40.0%的患者主诉有呼吸困难伴胸痛和咯血。其中，100.0%的患者出现呼吸困难，52.1%出现咯血，40.0%出现胸痛。31.1%的患者并发深静脉血栓形成（DVT），19.8%患有静脉曲张，9.5%在发病前30天内有手术史，22.0%患有肿瘤，3.6%在4天内伴有脑血管疾病，17.4%伴有感染，10.1%伴有原发性肺动脉高压，16.8%伴有心脏病。多因素分析显示，手术史、DVT和肿瘤与PE的发生有显著相关性[比值比（95%置信区间），OR（95%CI）分别为4.540（2.186 - 9.443）、0.325（0.155 - 0.682）、2.610（1.020 - 6.708），P<0.05或P<0.01]，而口服避孕药、原发性肺动脉高压和脑血管疾病与PE的发生相关性较小[OR（95%CI）分别为0.297（0.078 - 1.126）、3.210（0.855 - 12.110）、2.939（0.862 - 10.020），均P>0.05]。年龄和感染与PE的发生无显著相关性[OR（95%CI）分别为1.041（0.674 - 1.607）和0.820（0.410 - 1.665），均P>0.05]。
PE诊断困难，但随着认识的提高，PE的诊断率有所上升。有手术史、DVT或肿瘤病史且主诉不明原因呼吸困难、胸痛或咯血的患者，应进一步检查以确诊PE，从而提高PE患者的生存率。
