就诊时晕厥是亚大块和大块急性肺栓塞的替代指标。

Syncope on presentation is a surrogate for submassive and massive acute pulmonary embolism.

机构信息

Internal Medicine Department, Mercy Medical Center, Clinton, IA, USA.

Division of Pulmonary, Critical Care, Sleep and Allergy, University of Miami, Miller school of Medical, FL, USA; Section of Pulmonary, Department of Medicine, Miami VA Medical Center, Miami, FL, USA.

出版信息

Am J Emerg Med. 2018 Feb;36(2):297-300. doi: 10.1016/j.ajem.2017.11.014. Epub 2017 Nov 7.

DOI:10.1016/j.ajem.2017.11.014

PMID:29146419

Abstract

INTRODUCTION

There are conflicting data regarding the prognostic value of syncope in patients with acute pulmonary embolism (APE).

METHODS

We retrospectively reviewed data of 552 consecutive adults with computed tomography pulmonary angiogram-confirmed APE to determine the correlates and outcome of the occurrence of syncope at the time of presentation.

RESULTS

Among 552 subjects with APE (mean age 54years, 47% men), syncope occurred in 12.3% (68/552). Compared with subjects without syncope, those with syncope were more likely to have admission systolic blood pressure<90mmHg (odds ratio (OR) 5.788, P<0.001), and an oxygen saturation<88% on room air (OR 5.560, P<0.001), right ventricular dilation (OR 2.480, P=0.006), right ventricular hypokinesis (OR 2.288, P=0.018), require mechanical ventilation for respiratory failure (OR 3.152, P=0.014), and more likely to receive systemic thrombolysis (OR 4.722, P=0.008). On multivariate analysis, syncope on presentation was an independent predictor of a massive APE (OR 2.454, 95% CI 1.109-5.525, P=0.03) after adjusting for patients' age, sex, requirement of antibiotics throughout hospitalization, peak serum creatinine, admission oxygen saturation<88% and admission heart rate>100bpm. There was no difference in mortality in cases with APE with or without syncope (P=0.412).

CONCLUSION

Syncope at the onset of pulmonary embolization is a surrogate for submassive and massive APE but is not associated with higher in-hospital mortality.

摘要

引言

急性肺栓塞（APE）患者晕厥的预后价值存在争议。

方法

我们回顾性分析了 552 例经计算机断层扫描肺动脉造影确诊的 APE 连续成年患者的数据，以确定就诊时发生晕厥的相关性和结果。

结果

在 552 例 APE 患者（平均年龄 54 岁，47%为男性）中，12.3%（68/552）发生晕厥。与无晕厥患者相比，有晕厥的患者更有可能出现入院收缩压<90mmHg（优势比（OR）5.788，P<0.001），且在室内空气下血氧饱和度<88%（OR 5.560，P<0.001），右心室扩张（OR 2.480，P=0.006），右心室收缩无力（OR 2.288，P=0.018），需要机械通气治疗呼吸衰竭（OR 3.152，P=0.014），更有可能接受全身溶栓治疗（OR 4.722，P=0.008）。多变量分析显示，就诊时晕厥是大面积 APE 的独立预测因子（OR 2.454，95%CI 1.109-5.525，P=0.03），校正患者年龄、性别、住院期间抗生素使用需求、血清肌酐峰值、入院时血氧饱和度<88%和入院心率>100bpm 后。有或无晕厥的 APE 患者的住院死亡率无差异（P=0.412）。