Analysis on diagnosis of acute pulmonary thromboembolism in 316 cases

Abstract

Objective To analyze the clinical characteristics and diagnostic process of acute pulmonary thromboembolism (PTE),in order to reduce the missed diagnostic and misdiagnostic rate.Methods Clinical data of 316 cases with acute PTE in our hospital from January 2003 to October 2011 were collected,with their general information,risk factors,clinical features,auxiliary examinamtion,the first visited department and diagnostic time analyzed.Results A number of inpatients with acute PTE are growing year by year.Age≥60 years in 192 cases (60.76％),lower extremity deep vein thrombosis history in 101 cases (31.96％),96 cases of coronary heart disease (30.38％),83 cases of hypertension (26.27％),the recent history of operation in 52 cases (16.46％).Clinical manifestations of acute PTE are of diversity and without specificity,including dyspnea is most common,257 cases (81.34％),chest distress 32.28％,chest pain 24.37％,cough 21.52％,syncope 18.04％,haemoptysis 3.16％,among them experienced combination of dyspnoea,chest pain and haemoptysis only in 9 cases (2.85％).D-dimer＞ 500 μg/L in 222 (85.06％),D-dimer＜ 500 μg/L in 39 cases (14.94％％).Electrocardiogram showed SⅠ Q Ⅲ T Ⅲ in only 8 cases (3.62％).Through the lung ventilation/perfusion (V/Q) scan diagnosed as acute PTE in 255 cases (80.70％) and spiral CT pulmonary angiography (CTPA) diagnosed in 58 cases (18.35％).The first choice of most departments in emergency department,134 cases (42.41％),followed by the Department of respiration 130 cases (41.14％) and cardiovascular department of internal medicine 40 cases (12.66％),the remaining 12 patients were distributed in 8 departments.The average diagnostic time of all 316 cases was (44.57±53.52) h,and in the department of respiratory diseases the average diagnostic time was (31.45±48.05) h,emergency room was (45.52± 53.84) h and cardiovascular medicine department was (64.60 ± 42.84) h.The diagnostic time in respiratory department was siginficantly shorter than that in emergency department and in cardiovascular medicine department (P ＜ 0.05).Conclusions The incidence of acute PTE tends to increase yearly.Clinical manifestations are complicated and non specific.Its first visited departments are mainly include.So improving the understanding of the first visited department and strengthening the training work of the main departments,can effectively improve diagnostic level of acute PTE. Key words: Pulmonary thromboembolism ; Risk factors ; Diagnosis ; Diagnostic time