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find Author "许小毛" 2 results
  • 肺血栓栓塞症合并下肢深静脉血栓临床分析

    目的探讨肺血栓栓塞症患者合并下肢深静脉血栓(DVT)临床特征。方法对 2009 年 1 月至 2018 年 5 月北京医院收治的 343 例急性肺血栓栓塞症(PTE)患者的临床资料进行回顾性分析,根据合并下肢 DVT 情况分为近端 DVT 组、单纯下肢远端 DVT(IDDVT)组和无 DVT 组。比较各组临床特征及预后情况。结果343 例 PTE 患者平均(68.2±13.0)岁,男 165 例(48.1%)。158 例(46.1%)合并 DVT,其中下肢近端 DVT 91 例(57.6%),IDDVT 67 例(42.4%)。伴下肢 DVT 相关症状者 137 例(39.9%)中,检出 DVT 79 例(57.7%)。近端 DVT 组伴 DVT 相关症状的比例显著高于另两组(P=0.002 和 P<0.001)。近端 DVT 和 IDDVT 组白细胞及 D-二聚体水平显著高于非 DVT 组(均 P<0.05)。近端 DVT 组溶栓、置入下腔静脉滤器的比例均显著高于非 DVT 组(均 P<0.05),近端 DVT 组及 IDDVT 组低危 PTE 的比例显著低于无 DVT 组(P=0.042 和 P=0.013)。三组住院病死率差异无统计学意义(均 P>0.05)。多因素 Logistic 回归分析显示,目前吸烟(OR=2.96,95%CI 1.44~6.09,P=0.003)、DVT 病史(OR=2.27,95%CI 1.09~4.70,P=0.028)、DVT 症状(OR=3.26,95%CI 1.86~5.69,P<0.001)、D-二聚体>500 ng/mL(OR=4.47,95%CI 2.25~8.86,P<0.001)是 PTE 患者合并近端 DVT 的独立危险因素。DVT 病史(OR=7.27,95%CI 2.87~18.43,P<0.001)、脑血管病(OR=2.49,95%CI 1.07~5.76,P=0.033)、D-二聚体>500 ng/mL(OR=2.50,95%CI 1.30~4.82,P=0.006)是 PTE 患者合并 IDDVT 的独立危险因素。结论急性 PTE 患者伴发下肢 DVT 的比例接近 50%,其中超过一半为下肢近端 DVT。依据临床症状诊断 DVT 的可靠性较低,DVT 病史和 D-二聚体>500 pg/mL 是 PTE 患者合并下肢近端和远端 DVT 的独立危险因素。

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  • Cardiac Arrest Due to Fatal Pulmonary Thromboembolism: Two Cases Report and Literature Review

    Objective To describe the clinical profiles of cardiac arrest due to fatal pulmonary embolism (FPE), and review the literature on FPE diagnosis and treatment. Methods The clinical profiles of two cases with cardiac arrest for FPE were presented. A systematic search of Medline (1950 - 2014) and EMbase (1980-2014) was conducted to identify studies that investigated the use of thrombolytic medications to treat cardiac arrest for FPE. Results The fatal event of two patients occurred after surgery. Both of them survived with cardiopulmonary resuscitation and administration of thrombolysis and anticoagulation, but one of them had major bleeding during anticoagulation. Six articles were found involving 72473 cases of cardiac arrest due to pulmonary embolism (PE) or unstable massive PE. The thrombolytic agents were recombinant tissue plasminogen activator or streptokinase, but the administration and dose of thrombolytic agents were unclear. Overall, administration of thrombolytics can shorten the time to return of spontaneous circulation and improve the survival rate. There was, however, an increased risk of bleeding events following administration of thrombolytics. Conclusions Because of the high mortality of cardiac arrest for FPE, the clinician should correctly identify patients with a high likelihood of FPE. Early use of thrombolytics is very important and can potentially improve patient outcomes.

    Release date:2016-10-02 04:56 Export PDF Favorites Scan
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