Analysis of the diagnosis and treatment of acute pulmonary embolism in elderly patients in primary hospital / 中国基层医药

ABSTRACT

Objective To discuss the clinical characteristics of elderly patients with acute pulmonary embolism in common circumstance of primary hospital in order to improve the quality of diagnosis and treatment of such patients.Methods Retrospective analysis was made on case records of acute pulmonary embolism patients older than 60 years.Results Among 41 cases of acute pulmonary embolism,21 cases (51.2％) have co-exiting lower extremity deep vein thrombosis (DVT).The risk factors of pulmonary embolism includehypertension (23 cases,51.2％) ;malignant tumor (12 cases,21.3％) ;operation with time of anesthesia longer than 30 minutes (11 cases,26.8％) ;immobilization (11 cases,26.8％) ;diabetes mellitus (10 cases,24.4％) ;hyperlipidemia (9 cases,22.0％) ;obesity (8 cases,19.5％) ; prolonged atrial fibrillation (6 cases,16.6％).The major symptoms includedyspnea (36 cases,87.8％) ; cough (11 cases,26.8％) ; chest pain (8 cases,19.5％) ; syncope (6 cases,14.6％) ; palpitation (5 cases,12.2％) ; hemoptysis (5 cases,12.2％) ; agitation (2 cases,4.9％).Common signs includecyanosis (38 cases,92.7 ％) ; tachypnea (34 cases,82.9％) ; tachycardia (34 cases,82.9 ％) ; asymmetrical swelling of lower extremities (13 cases,31.7 ％) ; hypotension (7 cases,17.1％).Common finding of the patient's blood gas analysis is hypoxemia (39 cases,95.1％) and hypocapnemia (20 cases,48.8％).Common findings of chest X-ray are infiltration of the lungs and small amounts of pleural effusion.15 (36.6％) patients with DVT have both risk factors and typical clinical symptoms.Common findings of EKG were sinus tachycardia.Definite diagnosis of pulmonary embolism was made by CTPA (computed tomography pulmonary angiography) in 22 cases(53.7％).37 (90.2％) patients with PE (pulmonary thrombo-embolism) underwent anticoagulant therapy,4 (9.8％) patients underwent anticoagulant plus thrombolysis.The motility of this group was 19.5％.Conclusion The most common risk factors of elderly PE patients are chronic illness (most commonly COPD,hypertension,hyperlipidemia),malignant tumor,operation and immobilization.No clinical sign and laboratory test have high specificity.CTPA is the main way to make definite diagnosis.Anticoagulant is the primary therapy in elderly patients with PE,which is safe and efficacious.Thrombolysis of large area PE in elderly patients with risk factors of bleeding should be cautious.Excessive thrombolysis should be avoided.