【摘要】 目的:通过与非老年患者比较,分析老年肺栓塞患者的临床特征及危险分层。方法:通过回顾性分析,对64例老年肺栓塞患者和39例非老年肺栓塞患者的危险因素、临床表现、实验室检查、肺栓塞严重指数(PESI)和30 d死亡率进行对比分析。结果:下肢静脉血栓和制动是两组最常见的危险因素,老年组中糖尿病、心律失常、外伤或骨折及高血压的发生率高于非老年组,差异有统计学意义(P<0.05);呼吸困难、胸痛、咯血、咳嗽及晕厥的发生率方面比较,差异无统计学意义(P>0.05);老年组血气分析氧分压低于非老年组[(67.2±32.6)mm Hg vs(85.1±25.3)mm Hg)(1 mm Hg=0.133 kPa)],动脉氧饱和度低于非老年组[(84.4±16.4)%vs(92.1±9.4)%],D-二聚体明显高于非老年组[(3 178.4±308.6)μg/L vs(2 019.4±282.7)μg/L],两组比较,差异均有统计学意义(均P<0.05);老年组心电图发生完全或不完全右束支阻滞的患者比例高于非老年组(17.2%vs 2.6%),超声心动图出现右房、右室扩大的比例高于非老年组(48.4%vs 23.1%),两组比较,差异均有统计学意义(均P<0.05);PESI适用于老年肺栓塞患者的危险评估,两组患者30 d死亡率比较,差异无统计学意义(P>0.05)。结论:老年性肺栓塞患者合并危险因素多,临床表现不典型,存在较明显的低氧血症,D-二聚体增高,所以当老年患者出现呼吸困难和(或)低氧血症时应考虑肺栓塞的可能。更多还原

【Abstract】 Objective: To analyze the clinical characteristics and risk stratification of elderly patients with pulmonary embolism by comparing with non-elderly patients.Methods: Risk factors,clinical manifestations,laboratory tests,pulmonary embolism severity index(PESI) and 30-day mortality were compared between 64 cases of elderly patients and 39 cases of non-elderly patients with pulmonary embolism through a retrospective analysis.Results: Deep vein thrombosis and immobilization were the two most common risk factors in both groups.The incidences of diabetes,arrhythmia,trauma or fractures and hypertension in elderly group were higher than those in non-elderly group,there were significant differences between them(P<0.05).There was no significant difference in the incidence of dyspnea,chest pain,hemoptysis,cough and syncope between the two groups(P>0.05).Partial pressure and arterial oxygen saturation of oxygen of elderly group were significantly lower than those of non-elderly group [(67.2±32.6)mm Hg vs(85.1±25.3)mm Hg(1 mm Hg=0.133 kPa),(84.4±16.4)% vs(92.1±9.4)%],the level of D-dimer in elderly group was higher than that in non-elderly group [(3 178.4±308.6)μg/L vs(2 019.4±282.7)μg/L],and there were significant differences between them(all P<0.05).The incidences of complete or incomplete right bundle branch block in the ECG of elderly group than those of non-elderly group(17.2% vs 2.6%),the incidences of right atrial and right ventricular dilatation in the UCG of elderly group were higher than those of non-elderly group(48.4% vs 23.1%),and there were significant differences between them(all P<0.05).PESI was suitable for the risk assessment of elderly patients with pulmonary embolism,and there was no significant difference of 30-day mortality of the two groups(P>0.05).Conclusion: Elderly patients with pulmonary embolism combine with multiple risk factors and exhibit atypical clinical manifestations.And there are significant hypoxemia and high level of D-dimer in elderly patients with pulmonary embolism.Pulmonary embolism should be considered in elderly patients with dyspnea and(or) hypoxemia.更多还原