老年Wells低评分急性肺栓塞病人的临床特点分析

doi:10.3969/j.issn.1003-9198.2021.09.008

摘要/Abstract

摘要： 目的归纳总结老年Wells低评分急性肺栓塞(acute pulmonary embolism,APE)病人的临床特点。方法对我院2009年1月至2015年8月收治的75例老年Wells低评分疑似APE病人的风险因素、临床特征及辅助检查结果进行回顾性分析,将其中21例最终确诊为APE的病人作为病例组,另外54例排除APE的病人作为对照组。采用Logistic回归分析老年Wells低评分病人发生APE的影响因素。结果与对照组相比,病例组合并COPD、CHD病人的比例更高,临床症状以急性呼吸困难、慢性呼吸困难、胸闷、胸痛为主(P<0.05或<0.01)。病例组病人的PaO₂、PaCO₂、国际标准化比值(INR)水平均显著低于对照组,差异具有统计学意义(P<0.01)。Logistic回归分析显示,COPD(95％CI:1.421~261.620)、PaO₂(95％CI:0.883～0.984)、PaCO₂(95％CI:0.782～0.972)是老年Wells低评分病人发生APE的独立影响因素。结论当老年病人出现低PaO₂血症、低PaCO₂血症等表现,或既往有COPD等基础疾病,即使Wells低评分,仍需警惕APE可能。

关键词: Wells评分, 急性肺栓塞, 老年人, 临床特点, 鉴别诊断

Abstract: Objective To investigate the clinical characteristics of the elderly patients with acute pulmonary thromboembolism (APE) who showed low Wells score. Methods A retrospective analysis was performed on the risk factors, clinical characteristics and auxiliary examination results of 75 elderly patients with low Wells score who were suspected of APE in our hospital from January 2009 to August 2015. Among them, 21 patients finally diagnosed with APE were selected as the case group and the other 54 were selected as the control group. The influencing factors of APE in the elderly patients with low Wells score were analyzed by Logistic regression analysis. Results Compared with the control group, the proportions of the patients with chronic obstructive pulmonary disease (COPD) and coronary heart disease (CHD) in the case group were higher, and the clinical symptoms were mainly acute dyspnea, chronic dyspnea, chest tightness and chest pain (P<0.05 or <0.01). The levels of arterial oxygen partial pressure (PaO₂), arterial carbon dioxide partial pressure (PaCO₂) and International Normalized Ratio (INR) in the case group were statistically significant lower than those in the control group (P<0.01). Logistic regression analysis revealed that the independent influencing factors of APE in the elderly patients with low Wells score were COPD (95%CI: 1.421-261.620), PaO₂(95%CI: 0.883-0.984) and PaCO₂(95%CI: 0.782-0.972). Conclusions Clinical workers should pay attention to the elderly patients with low levels of PaCO₂ and PaO₂, or combined with COPD, even if they Wells score was low, it still need to be alert to the possibility of APE.

Key words: Wells score, acute pulmonary thromboembolism, aged, clinical characteristics, differential diagnosis

中图分类号:

R 563.5

柳毅, 殷少军, 孔志斌, 朱珍, 李虹, 宋爽, 宋一祎. 老年Wells低评分急性肺栓塞病人的临床特点分析[J]. 实用老年医学, 2021, 35(9): 923-926.

LIU Yi, YIN Shao-jun, KONG Zhi-bin, ZHU Zhen, LI Hong, SONG Shuang, SONG Yi-yi. Clinical characteristics of elderly patients with acute pulmonary thromboembolism presenting with low Wells score[J]. Practical Geriatrics, 2021, 35(9): 923-926.

参考文献

[1] KONSTANTINIDES S V, MEYER G, BECATTINI C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)[J]. Eur Heart J, 2020, 41(4):543-603.
[2] COHE A T, AGNELLI G, ANDERSON F A, et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality[J]. Thromb Haemost, 2007, 98(4):756-764.
[3] BUI P V, MOUALLA M, UPSON D J, et al. A possible association of diindolylmethane with pulmonary embolism and deep venous thrombosis[J]. Case Rep Med, 2016. DOI:10.1155/2016/7527098.
[4] WELLS P S, ANDERSON D R, RODGER M, et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer[J]. Thromb Haemost, 2000, 83(3):416-420.
[5] GEERSING G, ERKENS P M G, LUCASSEN W A M, et al. Safe exclusion of pulmonary embolism using the Wells rule and qualitative D-dimer testing in primary care: prospective cohort study[J]. BMJ, 2012, 345:e6564.
[6] STEIN P D, FOWLER S E, GOODMAN L R, et al. Multidetector computed tomography for acute pulmonary embolism[J]. N Engl J Med, 2006, 354(22):2317-2327.
[7] SULAIMAN A, ALAA A S, CAMELIA A, et al. Suboptimal implementation of diagnostic algorithms and overuse of computed tomography-pulmonary angiography in patients with suspected pulmonary embolism[J]. Ann Thorac Med, 2016, 11(4):254-260.
[8] MAMLOUK M D, VAN SONNENBERG E, GOSALIA R, et al. Pulmonary embolism at CT angiography: implications for appropriateness, cost, and radiation exposure in 2003 patients[J]. Radiology, 2010, 256(2):625-632.
[9] HENDRIKSEN J M T, LUCASSEN W A M, ERKENS P M G, et al. Ruling out pulmonary embolism in primary care: Comparison of the Diagnostic Performance of “Gestalt” and the Wells Rule[J]. Ann Fam Med, 2016, 14(3): 227-234.
[10] KLOK F A, ZIDANE M, DJURABI R K, et al. The physician’s estimation ‘alternative diagnosis is less likely than pulmonary embolism’ in the Wells rule is dependent on the presence of other required items[J]. Thromb Haemost, 2008, 99(1):244-245.

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