目的分析首次确诊急性肺血栓栓塞症(pulmonary thromboembolism,PTE)患者的临床特征,探讨急性PTE复发相关危险因素。方法收集2012年2月至2016年12月首都医科大学附属北京安贞医院急诊重症监护病房(emergency intensive care unit,EICU)收治的首次确诊急性PTE患者229例,年龄24~85岁,平均年龄(62.61±12.39)岁,男90例(39.3%),女139例(60.7%),通过门诊或电话对纳入患者进行为期三年的随访。单因素及多因素Logistic回归分析急性PTE患者复发相关危险因素。结果 229例患者中复发77例(33.6%),未复发152例(66.4%);复发组中无诱因急性PTE 63例(81.8%),有明确诱因急性PTE 14例(18.2%);未复发组中无诱因急性PTE 98例(64.5%),有明确诱因急性PTE 54例(35.5%),无诱发因素在复发组与未复发组两组间比较差异有统计学意义(P <0.05)。抗凝治疗6~12个月通过V/Q scan评估是否存在残余血栓,共有118例(51.5%)患者存在残余血栓,其中复发组中存在残余血栓48例(62.3%),无残余血栓29例(37.7%);未复发组中有残余血栓70例(46.1%),无残余血栓82例(53.9%),残余血栓在复发组与未复发组两组间比较差异有统计学意义(P <0.05)。复发组与未复发组抗凝疗程比较差异有统计学意义(P <0.05)。多因素Logistic回归分析进一步证实,无诱发因素(OR值2.097,95%CI为1.061~4.145,P=0.033)、残余血栓(OR值2.034,95%CI为1.081~3.826,P=0.028)、抗凝疗程13~24个月与6~12个月比较(OR值0.405,95%CI为0.185~0.887,P=0.024)、> 24个月与6~12个月比较(OR值0.204,95%CI为0.093~0.445,P <0.001)与急性PTE复发独立相关。结论急性PTE患者复发风险较高,特别是无诱因急性PTE;首次确诊无诱因急性PTE随访过程中发现肿瘤等诱发因素,提示临床医生随访中需要对无诱因急性PTE患者给予关注;无诱因急性PTE、规范抗凝后残余血栓、抗凝疗程是影响复发的独立危险因素。Objective The clinical characteristics of the patients with acute pulmonary thromboembolism( PTE) diagnosed for the first time were analyzed,and the risk factors associated with acute PTE recurrence were discussed. Methods 229 cases of first episode acute PTE patients were admitted to the emergency intensive care unit( EICU) of Beijing Anzhen Hospital Affiliated to Capital Medical University from February 2012 to December 2016,aged 24-85 years old,with an average age of( 62.61 ±12. 39) years old,including 90 males( 39. 3%) and 139 females( 60. 7%). Enrolled patients were followed up by outpatient or telephone for a period of 3 years. The risk factors associated with acute PTE recurrence were analyzed by univariate Logistic regression and multivariate Logistic regression.Results Among the 229 patients,77 cases( 33. 6%) were in the recurrent group and 152 cases( 66. 4%) were in the non-recurrent group. In the recurrence group,there were 63 cases( 81. 8%)with unprovoked PTE and 14 cases( 18. 2%) with definite incentive PTE. In the non-recurrence group,there were 98 cases( 64. 5%) with unprovoked PTE and 54 cases( 35. 5%) with definite incentive PTE. The unprovoked pulmonary embolism between the recurrence group and the non-recurrence group was statistically significant( P < 0. 05). Patients with residual perfusion defects were assessed by V/Q scan after 6-12 months of standard anticoagulant therapy. There were 118 patients( 51. 5%) in the residual perfusion defects group. Among them,48 patients( 62. 3%) in the recurrent group had residual pulmonary perfusion defect,29 patients( 37. 7%) had no residual pulmonary perfusion defect,70 patients( 46. 1%) in the non-recurrent group had residual pulmonary perfusion defect,and 82 patients( 53. 9%) had no residual pulmonary perfusion defect. There was a statistically significant difference in residual perfusion defects between the recurrence group and the non-recurrence group( P < 0. 05). There was statistical significance in the anticoagulant course between the recurrence g
机构地区首都医科大学附属北京安贞医院急诊危重症中心 首都医科大学附属北京安贞医院核医学科 北京心肺血管疾病研究所
出处《中国急救医学》 CAS CSCD 北大核心 2021年第2期104-110,共7页Chinese Journal of Critical Care Medicine
基金北京市朝阳区科学技术和信息化局-朝阳区社会发展科技计划项目(CYSF2049)。
关键词急性肺栓塞 残余血栓 复发Acute pulmonary thromboembolism Residual clots Recurrent
分类号R56 [医药卫生—呼吸系统]
