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題 名 | 肺栓塞症:62例之臨床與檢驗之特徵=Pulmonary Embolism: Clinical and Laboratory Features in 62 Patients |
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作 者 | 方柏仁; 江正文; 李英雄; | 書刊名 | 長庚醫學 |
卷 期 | 19:4 1996.12[民85.12] |
頁 次 | 頁325-330 |
分類號 | 415.467 |
關鍵詞 | 肺栓塞症; 深部靜脈血栓; 肺核醫掃描檢查; Pulmonary embolism; Deep venous thrombosis; Lung scan; |
語 文 | 中文(Chinese) |
中文摘要 | 背景:肺栓塞症是一種不常見的疾病,因為其臨床表徵具多樣性且非特異性之特徵,所以常未被診斷出來。 方法:本文搜集了經核醫肺灌注掃描診斷為高度可能性肺栓塞之病例共62例,就其臨床表徵與檢驗特徵加以分析。 結果:62例中男性有26例,女性有36例,平均年齡為63[]11歲(範圍37至90歲)。臨床症狀包括:喘氣(92%),胸痛、胸悶(65%),咳嗽(50%),喘鳴(29%),腿部腫脹(32%),咳血(24%),昏厥(8%),腿痛(10%)。臨床徵象包括:呼吸急促(每分鐘20次或以上)(79%),心搏過速(37%),腿部靜脈血栓(29%),發紺(8%),發燒(38.5[]C以上)(2%)。可能之誘發因素包括:長期臥床(18%),外科手術後(5%),曾患腿部靜脈血栓(5%),惡性腫瘤(5%),曾患肺栓塞症(3%)。動脈血氣體分析(當病人呼吸室內空氣情況下)呈現PH值之平均值7.46[]0.06,氣壓之平均值為64.5[]12.1毫米汞柱,二氧化碳分壓之平均值為35.5][]4.6毫米汞柱,動脈一肺泡氣壓差之平均值為36.5[]16.6毫米汞柱。心電圖之變化包括:非特異性之ST節段與T波之變化(61%),竇性心搏過速(20%),S[]Q[]T[](15%),心房纖維性顫動(16%),不完全性右束支傳導阻斷(10%),完全性右束支傳導阻斷(8%),心房早期收縮(7%),心室上快速心律(2%)。胸部X光之變化包括:心臟擴大(48%),局部肺血管紋路減少(31%),肺萎陷(5%),肋膜腔積液(5%),楔形肺部浸潤性病灶(3%),橫膈膜上移(6%)。62例中有49例做了腿部的strain-gauge plethysmography檢查,結果28例呈現陽性結果,此28例中有18例在臨床上有腿部靜脈血栓之跡象。所有62例皆接受肝素治療,隨後給予口服coumadin。住院期間有8例死亡,其中6例是突然死亡,其死因可能與肺栓塞症有關,住院中之死亡率為10%(6/62),另外2例則因其他併發症而死於敗血症。 結論:肺栓塞症之臨床表徵與某些心、肺疾病之臨床表徵很相似,所以當病人以「急性心、肺症狀」為臨床表徵時應將肺栓塞症列入鑑別診斷的考慮項目中,當查無心、肺疾病可以解釋症狀時,就應考慮肺栓塞症的可能性,有須要做肺核醫掃描或肺動脈血管攝影檢查以證實或排除肺栓塞症。 |
英文摘要 | The clinical and laboratory features in 62 patients with acute pulmonary embolism were analized. There were 26 males, and 36 females with mean age of 63[]11 (renge 37 to 90). The clinical symptoms include: dyspnea (92%), chest pain and/or chest tightness (65%), cough (50%), wheezing (29%), leg swelling (32%), hemoptysis (24%), syncope (18%), leg pain (10%). Clinical signs include: tachypnea (respiratory rate [] 20 per minute) (79%), tachycardia (37%), deep vein thrombosis (29%), cyanosis (8%), fever (>38.5[]C). The possible predisposing factors include: immobilization (18%), surgery (5%), deep vein thrombosis, ever (5%), malignancy (5%), pulmonary embolism, ever (3%). Arterial blood gas analysis (while patients breathed room air) revealed mean PH of 7.46[]0.06, mean PO[] of 64.5[]11.1 mmHg, mean PCO[] of 35.3[]4.6 mmHg, mean Alveolar-arterial O[] difference of 36.5[]16.6 mmHg. The electrocardiographic changes include: nonspecific ST-T change(61%), sinus tachycardia (20%), S[]Q[]T[] pattern (15%), atrial fibrillation (16%), incomplete right bundle branch block (10%), complete right bundle branch block (8%), atrial premature contraction (7%), paroxysmal supraventricular tachycardia (2%). The chest X-rey findings include: cardiomegaly (48%), regional hypovascularity(31%), atelectasis (5%), pleural effusion (5%), wedge-shaped infiltrate (3%), elevated diaphragm (6%). Venous plethysmography was performed in 49 of 62 patients. Of these 49 patients, 28 patients revealed positive finding. Of these 28 patients with positive finding, 18 patients had clinical evidence of deep venus thrombosis. The in-hopsital mortality rate was 10% (6/62). |
本系統中英文摘要資訊取自各篇刊載內容。