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  • 秦家骏,陈先震*.初诊为神经重症监护病房医院获得性肺炎的肺栓塞危险因素分析[J].第二军医大学学报,2018,39(11):1277-1283    [点击复制]
  • QIN Jia-jun,CHEN Xian-zhen*.Risk factors of pulmonary embolism in patients initially diagnosed as neurointensive care unit hospital-acquired pneumonia[J].Acad J Sec Mil Med Univ,2018,39(11):1277-1283   [点击复制]
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初诊为神经重症监护病房医院获得性肺炎的肺栓塞危险因素分析
秦家骏,陈先震*
0
(同济大学附属第十人民医院神经外科, 上海 200072
*通信作者)
摘要:
目的 探讨D-二聚体水平升高的初诊为神经重症监护病房医院获得性肺炎(NICUHAP)患者肺栓塞(PE)发病的危险因素。方法 采用病例-对照研究的方法,收集同济大学附属第十人民医院神经外科2007年1月至2018年1月初诊考虑NICUHAP病例的病历资料。根据高分辨率CT肺动脉成像(CTPA)检查结果,将患者分为PE组和非PE组,计算PE组的肺动脉阻塞指数(PAOI)。资料经单因素及多因素logistic回归分析筛选PE发病的危险因素。结果 129例初诊NICUHAP患者纳入研究并行CTPA检查,其中确诊为PE的患者75例,D-二聚体水平中位数为3.97 mg/L;非PE患者54例,D-二聚体水平中位数为0.88 mg/L,两组间差异有统计学意义(P<0.05)。75例确诊PE患者PAOI在30%以下者有70例,占93.3%。D-二聚体水平与PAOI无相关性。年龄、冠心病、慢性阻塞性肺疾病、下肢静脉曲张、胸痛、气促、咯血、胸闷、发热(体温>38.5℃)、心肌肌钙蛋白I升高是PE发生可能的独立危险因素。结论 发生PE的初诊NICUHAP患者D-二聚体水平高于非PE患者,但与PAOI无明显相关性。如果初诊NICUHAP患者年龄>60岁,合并冠心病、慢性阻塞性肺疾病、下肢静脉曲张,出现胸痛、气促、咯血、心肌肌钙蛋白I升高,体温不高于38.5℃,需考虑PE。
关键词:  D-二聚体  神经重症监护病房医院获得性肺炎  肺栓塞  病例对照研究
DOI:10.16781/j.0258-879x.2018.11.1277
投稿时间:2018-06-08修订日期:2018-08-13
基金项目:上海市申康医院发展中心专科疾病临床“五新”转化项目(16CR3048A).
Risk factors of pulmonary embolism in patients initially diagnosed as neurointensive care unit hospital-acquired pneumonia
QIN Jia-jun,CHEN Xian-zhen*
(Department of Neurosurgery, the Tenth People's Hospital, Tongji University, Shanghai 200072, China
*Corresponding author)
Abstract:
Objective To explore the risk factors of pulmonary embolism (PE) in the patients initially diagnosed as neurointensive care unit hospital-acquired pneumonia (NICUHAP) with increased D-dimer level. Methods A case-control study was taken to observe the clinical data from the patients with NICUHAP who were initially diagnosed in the Tenth People's Hospital of Tongji University between Jan. 2007 and Jan.2018. According to the results of computed tomography pulmonary angiography (CTPA) examination, the patients were divided into PE group and non-PE group. The pulmonary artery occlusion index (PAOI) was calculated in the patients of the PE group. Univariate and multivariate logistic regression analyses were performed to explore the risk factors for PE. Results A total of 129 patients initially diagnosed as NICUHAP were included in this study and received CTPA examination. The median D-dimer levels of PE patients (n=75) and non-PE patients (n=54) were 3.97 mg/L and 0.88 mg/L, respectively, and the difference was significant (P<0.05). The PAOIs of 70 (93.3%) PE patients were below 30%. There was no significant correlation between the D-dimer level and PAOI. Age, coronary heart disease, chronic obstructive pulmonary disease, varicose veins of lower limbs, thoracodynia, shortness of breath, hemoptysis, chest tightness, fever (body temperature>38.5℃), and elevated cardiac troponin I level were possible independent risk factors for PE. Conclusion The patients initially diagnosed as NICUHAP with PE have elevated D-dimer level compared with the patients without PE. There is no significant correlation between D-dimer level and PAOI. The patients initially diagnosed as NICUHAP, who are older than 60 years, or accompanied with coronary heart disease, chronic obstructive pulmonary disease, varicose veins of lower limbs, thoracodynia, shortness of breath, hemoptysis, elevated cardiac troponin I level or with a body temperature below 38.5℃, need CTPA examination to exclude PE.
Key words:  D-dimer  neurointensive care unit hospital-acquired pneumonia  pulmonary embolism  case-control studies