摘要目的 调查分析北京地区不同级别医院肺血栓栓塞症(PTE)住院患者临床特点及诊治现状,客观评价不同级别医院PTE住院患者的规范化诊治水平.方法 回顾性调查2011年7月到2012年6月1年间北京地区18家医院(8家三级,10家二级)PTE住院患者的临床资料.对人口学资料、危险因素、临床表现、诊断方法、治疗情况等进行分析.结果 1年间住院PTE患者206例,男性占53.4％,平均年龄(71.6±16.0)岁.临床表现以呼吸困难为主,达157例(157/206,76.2％).59例(59/206,28.6％)的患者存在下肢肿胀.177例(177/206,86.0％)的患者CT肺动脉造影(CTPA)检查确诊PTE,29例(29/206,14.0％)的患者通过核素肺通气灌注显像确诊.154例(154/206,74.8％)患者进行了超声心动图检查,81.1％的患者进行了深静脉血栓形成(DVT)的筛查.57.8％的患者进行了脑钠肽(BNP)或N末端脑钠肽前体(NT-proBNP)检查,47.6％的患者进行了肌钙蛋白检查.所有患者均采用了抗凝治疗,8.25％的患者采取了溶栓治疗,无二次溶栓治疗的病例;1.5％的患者进行了下腔静脉滤器植入术.不良反应主要表现为出血(4.4％)、肝功能异常(9.2％).住院期间的病死率为2.9％.二级医院同三级医院相比,确诊时间较短,中高危患者多,行核素肺通气灌注显像者少.结论 在北京地区,无论是二级医院还是三级医院PTE的规范化诊断与治疗水平较高,但需要在PTE的危险分层及寻找PTE成因方面进一步加强.

abstractsObjective To investigate the clinical characteristics of inpatients with pulmonary thromboembolism (PTE) and the status of its diagnosis and treatment in different hospitals in Beijing.Method The clinical data of the inpatients with PTE from 18 hospitals with different medical levels in Beijing were retrospectively investigated from July 2011 to June 2012.The demographic characteristics,risk factors,clinical manifestations,diagnosis and treatment were recorded and analyzed.Results A total of 206 inpatients with PTE were recruited,of whom 53.4％ were males,and the mean age was (72 ± 16)years.In terms of the clinical manifestations,76.2％ patients had dyspnea,and 28.6％ had lower limb edema.The diagnosis in 86％ patients was confirmed by CTPA and 14％ by ventilation perfusion scan.Echocardiography was performed in 74.8％ patients,screening for deep vein thrombosis.In 81.1％ patients,and BNP or NT-proBNP measurements in 57.8％ patients.CTNI was tested in 47.6％ patients.All patients received anticoagulant therapy,and 8.25％ of the patients received thrombolysis.No cases received secondary thrombolysis therapy.1.5％ of the patients received inferior vena cava filter implantation.The main adverse events were bleeding (4.4％) and liver dysfunction (9.2％).The mortality during hospitalization was 2.9％.Compared with tertiary hospitals,the time from admission to diagnosis was shorter,the proportion of intermediate-and high-risk patients was higher in secondary hospitals and fewer patients received lung ventilation perfusion scan.Conclusion The status of diagnosis and treatment of inpatient with PTE in hospitals of different medical levels in Beijing is relatively satisfactory,while more attention should be paid to the risk stratification and the identification of etiology.