老年和非老年急性肺栓塞患者临床特点比较

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摘要目的比较分析老年和非老年急性肺栓塞患者(acute pulmonary embolism,APE)的临床特点。方法对医院近7年来119例APE患者进行回顾性分析,根据年龄分为两组,即老年 (年龄≥65岁) 组53例和非老年(年龄<65岁)组66例,对两组的易患因素、临床表现、辅助检查、诊断及治疗等进行分析比较。结果 (1)老年组合并高血压(49.1%)、房颤(28.3%)、消化道溃疡或出血(9.8%)明显高于非老年组合并高血压(25.8%)、房颤(10.6%)、消化道溃疡或出血(0);(2)老年组下肢肿胀痛(15.1%)比非老年组下肢肿胀痛(4%)更常见;(3)老年组ST、T改变(90.5%)、房颤(17.0%)明显高于非老年组ST、T改变(63.2%)、房颤(1.5%),非老年组窦速、右束支传导阻滞(84.2%)明显高于老年组(52.4%)。(4)老年组PCO₂＜35 mmHg(65.8%)明显高于非老年组(40.9%);非老年组PO₂＜80 mmHg(95.5%)明显高于老年组(76.3%)。(5)APE较易误诊为心内科疾病,老年组误诊率(30.1%)明显高于非老年组(15.1%)。老年组更多采用抗凝治疗,非老年组更多采用抗凝+溶栓治疗。两组住院期间病死率无明显差异。结论老年与非老年APE合并的基础疾病、临床表现及治疗方式有所不同,老年组误诊率较高。对有下肢肿胀痛,低碳酸血症及心电图表现为ST-T改变、房颤的老年患者应警惕 APE,以减少漏诊及误诊。

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	张晔
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	邹芬芳

关键词 ：肺栓塞, 老年/非老年, 临床特点

Abstract：Objective To analyze the different clinical characteristics of acute pulmonary embolism (APE) between the elderly and non-elderly people.Methods Clinical data on 119 APE patients treated in the General Hospital of Chinese People’s Armed Police Force over the past seven years was analyzed retrospectively. These patients were assigned to two groups: the elder group above 65 (n=53) and the younger group under 65 (n=66).Risk factors,clinical symptoms, auxiliary examination , diagnosis and therapies of the two groups were analyzed and compared.Results ① Patients of the elder group tended to be complicated with hypertension, atrial fibrillation, peptic ulcer and bleeding, accounting for 49.1%, 28.3% and 9.8%, respectively, compared with 25.8%, 25.8% and 0 in the younger group. ②Lower limb swelling pain in the elder group was more common than in the younger group(4%).③ ST-T changes and atrial fibrillation in the elder group (90.5% and 17.0%) were more common than those in the younger group(63.2% and 1.5%) while the incidence of the sinus tachycardia and bundle branch block in the younger group (84.2%) was higher than that in the elder group (52.4%).④ PCO₂＜35mmHg in the elder group (65.8%)was higher than that in the younger group(40.9%) and PO₂＜80mmHg in the younger group (95.5%) was higher than that in the elder group (76.3%).⑤ APE was easily misdiagnosed as a cardiovascular disease and the misdiagnosis rate in the elder group (30.1%) was higher than in the younger group (15.1%). ⑥ Anticoagulant therapy was more common in the elder group while anticoagulant therapy combined with intravenous thrombolysis was more popular in the younger group. There was no significant difference in the short-term mortality rate between the two groups during hospitalization.Conclusions The underlying disease, clinical symptoms and therapies for APE are different between the elderly and non-elderly patients. Misdiagnosis is more common in the elderly group than in the younger group, which is why physicians should pay more attention to the elderly with lower limb swelling pain, hypercapnia, ST-T change or atrial fibrillation in order to decrease cases of misdiagnosis of APE.

Key words： acute pulmonary embolism the elderly/ non-elderly clinical characteristics

收稿日期: 2017-06-11

ZTFLH:

R563

通讯作者: 高红梅,E-mail:gaohm777@sina.com

作者简介: 张晔,硕士,住院医师。

引用本文:

张晔, 高红梅, 张健鹏, 李志民, 陈文丽, 邹芬芳. 老年和非老年急性肺栓塞患者临床特点比较[J]. 武警医学, 2018, 29(2): 163-167. ZHANG Ye, GAO Hongmei, ZHANG Jianpeng, LI Zhimin, CHEN Wenli, ZOU Fenfang. Comparative study of acute pulmonary embolism between the elderly and non-elderly patients. Med. J. Chin. Peop. Armed Poli. Forc., 2018, 29(2): 163-167.

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http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2018/V29/I2/163

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