【摘要】 目的:研究联合应用D-二聚体（D-dimer）和血气分析对胸闷和（或）不典型胸痛患者诊断肺栓塞的价值。方法:对因胸闷和（或）不典型胸痛入院患者常规急诊行D-dimer、血气分析、心肌酶、心电图（ECG）等快速检查。对于血D-dimer≥500μg/L和血PO₂<80mmHg,且排除急性心肌梗死和急性左心衰竭患者行胸部CT检查。结果:入选患者75例[男48例、女27例;平均年龄为(63±12岁]。D-dimer≥500μg/L和PO₂<80mmHg患者为25例。经胸部CT证实肺栓塞为8例（32％）;诊断冠心病7例（28％）;慢性支气管炎4例（16％）;心脏神经官能症5例（20％）;房性心律失常1例（4％）。在8例肺栓塞患者中,大块肺栓塞2例。ECG表现S₁Q₃T₃1例（12.5％）;TV_1～4倒置2例（25％）,STV_1～4段压低2例（25％）,右束支阻滞1例（12.5％）,ECG正常2例（25％）。1例大块肺栓塞患者发生猝死。7例出院。随访3～8个月,无不良事件。2例患者偶尔有胸闷感。结论:常规联合检测D-dimer和血气分析有助于对胸闷或不典型胸痛患者进行肺栓塞的诊断和鉴别诊断。更多还原

【Abstract】 Objective: To study the value of the talted use of D -- dimer and blood gas analysis on the patients（pts） with dyspneaand atypical chest pain for diagnosing pulmonary embolism（PE）. Methods: The plasma D--dimer, blood gas analysis, myocardial en-zyme and ECG on the pts with dyspnea and atypical chest pain were done. Pleuritic CT would be performed on the pts with plasmaD--dimer≥500μg/L and PO₂< 80mmHg in arterial blood gas.Results: 75 pts were enroll[male48, female27; mean ages（63±12）y]. The pts with plasma D--dimer≥500μg/L and PO₂ < 80mmHg are 25. The final diagnosis were: PE 8（32% ）pts, CHD 7（28%）,COPD 4（16%）, Cardiac panic disorder 5（20%）, artial arrhythmia 1（4%）. 2pts are massive PE. ECG presentation were: S₁Q₃T₃ pat-tern in 1 pt, TV_1-4 inversion 2pts, STV_1-4 segment depression 2pts, righ bundle branch block 1pt, normal 1pt. Sudden death in 1ptwith massive PE. No effects occurred during follow--up. 2pts sometime have dyspnea. Conclusion: It is helpful to diagnose pul-monary embolism on the patients with dyspnea and atypical chest pain by the united use of D--dimer and blood gas analysis.更多还原