摘要目的 分析探讨老年肺血栓栓塞症(PTE)的临床特点,提高诊治水平.方法 回顾性分析北京协和医院2006年1月至2009年1月期间年龄≥60岁的急性肺栓塞住院患者的临床资料,其中男32例,女36例,年龄范围60～88岁,平均(72±6)岁.结果 68例急性肺栓塞患者(33例同时存在深静脉血栓)发生肺栓塞的危险因素为高血压(38/68)、恶性肿瘤(22/68)、手术(20/68)、制动(20/68)、糖尿病(16168)及肥胖(14/68)等,其中48例患者同时具有2个以上危险因素.患者的主要临床表现为呼吸困难(53/68)、咳嗽(18/68)、胸痛(9/68)、心悸(9168)、晕厥(9/68)及下肢不对称性肿胀(21/68),其中62例患者血气分析表现为低氧血症,血浆D-二聚体阳性率达84%(47/56),X线胸片主要表现为肺部浸洞影(26/68)和胸腔积液(13/68),心电图主要表现为非特异性ST-T改变(40/68)及窦性心动过速(16/68).经CT肺动脉造影确诊47例,经核素肺通气/灌注显像确诊20例.PTE抗凝治疗61例,溶栓治疗5例,放置下腔静脉滤器5例,56例经治疗后好转,出血事件发生率4%(3/68);病死率18%(12/68).结论 老年肺栓塞最常见的危险因素为慢性疾病、恶性肿瘤、手术和制动,其临床表现及辅助检查缺乏特异性,CT肺动脉造影是主要的确诊手段,抗凝治疗是老年肺栓塞患者最基本治疗,安全有效,应防止过度溶栓治疗和放置下腔静脉滤器.

abstractsObjective To explore the clinical characteristics of acute pulmonary thromboembolism (FIE) in elderly patients, in order to improve the diagnosis and treatment of the disease. Method The clinical data were reviewed for patients aged over 60 years old hospitalized with acute PTE in Peking Union Medical Collage Hospital from January 2006 to January 2009. Results 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). Conclusion 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.Anticoagulatian was the basic treatment for FIE in elderly patients and it was safe and effective, while the overuse of thrombelytic therapy and vena cava filter should be avoided.