Di Ricco G, Melillo E, Rindi M, Marini C, Vigotti M, Giuntini C
Istituto di Fisiologia Clinica del CNR, Pisa.
G Ital Cardiol. 1988 Jul;18(7):578-84.
Seven hundred fifty four consecutive cases of pulmonary embolism, diagnosed between 1969 and 1982 at S. Chiara Hospital in Pisa, were examined in order to assess the causes and the rate of the early mortality. Full documentation was not obtained in 47 cases (6.2%) and they were excluded from the study; 81 (11.4%) of the remaining 707 died within 30 days of diagnosis, and in 56.8% of them pulmonary embolism was the primary cause of death. The survival rate was 90.6% in patients with apparently primary pulmonary embolism, 89.8% in post surgical cases, 81.5% in cardiac patients and 75% in patients affected by neoplasm. Twenty five per cent of patients were not treated during the acute phase, because the diagnosis was made more than one month after the onset of symptoms or because the fear of bleeding precluded anticoagulant treatment. The incidence of fatal haemorrhage during treatment was 0.5% overall, and 0.4% in surgical patients. Mortality was 9.2% in patients who received treatment, versus 25.2% in untreated patients. Sixteen fatal recurrent embolisms occurred after the end of treatment: 11 were observed in patients not treated with oral anticoagulants. Routine autoptic examinations, performed in 44.4% of the cases, often demonstrated both recent and organized emboli, especially in cardiac patients. Recurrence of pulmonary embolism may account for both the severity of clinical patterns and the high mortality rate in the early phase of treatment.
为评估1969年至1982年间在比萨圣基亚拉医院确诊的754例连续性肺栓塞病例的病因及早期死亡率，对其进行了检查。47例（6.2%）未获得完整资料，被排除在研究之外；其余707例中有81例（11.4%）在诊断后30天内死亡，其中56.8%的患者肺栓塞是主要死因。明显原发性肺栓塞患者的生存率为90.6%，外科手术后患者为89.8%，心脏病患者为81.5%，肿瘤患者为75%。25%的患者在急性期未接受治疗，原因是症状出现一个多月后才作出诊断，或因担心出血而未进行抗凝治疗。治疗期间致命性出血的发生率总体为0.5%，外科手术患者为0.4%。接受治疗的患者死亡率为9.2%，未接受治疗的患者为25.2%。治疗结束后发生了16例致命性复发性栓塞：11例见于未接受口服抗凝剂治疗的患者。44.4%的病例进行了常规尸检，常显示有近期和机化的栓子，特别是在心脏病患者中。肺栓塞的复发可能是临床症状严重程度及治疗早期高死亡率的原因。
