目的:探讨不同抗凝强度华法林应用于非瓣膜性心房颤动患者的可行性及安全性。方法:91例非瓣膜性心房颤动患者随机分为三组:低抗凝强度［国际标准化比率（INR）1.5～1.9］；标准抗凝强度组（INR 2.0～2.5）和阿司匹林组，观察三组血栓栓塞并发症和出血等不良反应的发生率以及C反应蛋白浓度变化。结果:标准抗凝强度组血栓发生率低于低抗凝强度组、阿司匹林组，不同强度华法林抗凝组血栓栓塞率比较差异无统计学意义；标准抗凝强度组出血发生率低于其他两个组，但三组患者出血发生率比较无统计学意义（Pgt;0.05）；治疗后低抗凝强度组、标准抗凝强度组C反应蛋白浓度明显低于治疗前（Plt;0.05），治疗后阿司匹林组C反应蛋白水平明显高于低抗凝强度组、标准抗凝强度组（Plt;0.01）。结论:华法林抗凝维持INR值在2.0～2.5时能降低非瓣膜性房颤患者血栓栓塞发生率，出血发生率低，有效性和安全性好。
Objective To investigate the value of different imageology methods in the diagnosis of acute pulmonary thromboembolism (PTE).Methods 22 cases diagnosed acute PTE in the last two years were retrospectively analysed，including 4 cases diagnosed by clinical signs and symptoms who did not perform further examinations due to severity of the disease (2 cases confirmed by autopsy)，18 cases diagnosed by either two methods of computed tomographic pulmonary angiography (CTPA)，ultrasound，radioisotope scanning of lung and pulmonary arteriography.The diagnostic positive rate of different methods were measured.Results 15 of the 18 subjects were performed CTPA，with a positive rate of 80.0% (12/15).Nuclide detection was performed in 14 cases，in which 5 cases were performed simple pulmonary infusion scanning，9 cases by lung ventilation/perfusion scanning，resulted in a positive rate of 92.9% (13/14).10 cases were performed nuclide phlebography on the low extremity simultaneously，deep phlebothrombosis was found in 5 subjects，and unnormal formation of collateral circulation，blocked blood circulation，stenosis of lumens，and valve disfunction et al were found in other 5 cases.16 cases were performed heart color ultrasound detection，in which 2 were found normal，one was directly found thrombus，and the other 8 cases were found indirect manifestations of acute PTE，including right ventricular enlargement，pulmonary artery hypertension，tricuspid backstreaming et al，with a diagnosing rate of 56% (9/16).Deep phlebothrombosis was found in 6 of the 10 cases who were performed color Doppler ultrasonography on the lower extremity，and one was found with valve function impaired.Conclusions CTPA possesses high positive rate in diagnosing acute PTE with promptness，convenience and reliability，thus can be taken as the front-line detection device.Radioisotope scanning of lung associated with same-time phlebography on the low extremity also has fairly high positive rate to diagnosing acute PTE and make it easy.
Objective To compare the clinical efficacy and safety of thrombolysis with anticoagulation therapy for patients with acute sub-massive pulmonary thromboembolism. Methods The clinical data of 84 patients with acute sub-massive pulmonary thromboembolism were analyzed retrospectively, mainly focusing on the in-hospital efficacy and safety of thrombolysis and/ or anticoagulation. The efficacy was evaluated based on 6 grades: cured, markedly improved, improved, not changed, deteriorated and died. Results Among the 84 patients,49 patients received thrombolysis and sequential anticoagulation therapy( thrombolysis group) , 35 patients received anticoagulation therapy alone( anticoagulation group) . As compared with the anticoagulation group, the thrombolysis group had higher effective rate( defined as patients who were cured, markedly improved or improved, 81. 6% versus 54. 3%, P = 0. 007) , lower critical event occurrence ( defined as clinical condition deteriorated or died, 2. 0% versus 14. 3% , P = 0. 032) . There was no significant difference in bleeding rates between the two groups ( thrombolysis group 20. 4% versus anticoagulation group 14. 3% , P gt; 0. 05) . No major bleeding or intracranial hemorrhage occurred in any of the patients. Conclusions Thrombolysis therapy may be more effective than anticoagulation therapy alone in patients with acute sub-massive pulmonary thromboembolism, and thus warrants further prospective randomized control study in large population.
Objective Pulmonary thromboembolism ( PTE) is associated with various risk factors which existed in multidisciplinary patients. It is necessary to know what the role of pulmonologists in the diagnosis of PTE. Methods Data were collected from thirteen general hospitals in Guangxi. Hospital records of PTE cases from1995 to 2007 were retrospectively analyzed. The rates of PTE to inpatients between the respiratory departments and other departments or between different periods were compared. Results The rates of PTE of inpatients in respiratory departments ( 1. 55‰, 170/109 577) was higher than that in other departments ( 0. 03‰, 69/2 322 944) , P lt; 0. 001. Compared to that of 1995-2001, the rate of PTE of inpatients in the respiratory departments in the last 6 years increased by 3220. 22% [ ( 2. 43‰,167/68 638) vs ( 0. 07‰, 3 /40 939) ] . During 1995-2001 and 2002-2007, the rates of PTE of inpatients in the respiratory departments were higher than those in other departments [ 0. 004‰ ( 4/1 012 830) during 1995-2001 and 0. 05‰( 65 /1 310 114) during 2002-2007, respectively] , P lt; 0. 01. Conclusion pulmonologists play an important role in the diagnosis of PTE in the recent years.
Objective To investigate the prevalence and risk factors of venous thromboembolism ( VTE) in patients with acute exacerbation of COPD ( AECOPD) . Methods The patients with AECOPD admitted fromJune 2006 to February 2010 in Beijing Tongren Hospital were included for analysis. VTE was investigated in all patients ( whether or not clinically suspected) by a standardized algorithm based on D-dimer testing, 4-limb venous ultrasonography, and the patients with clinically suspected pulmonarythromboembolism ( PTE) received ventilation/perfusion scan and ( or) computed tomography pulmonary angiography ( CTPA) . Results The total number of patients with AECOPD was 282, and the prevalence of VTE was 6% ( 17 /282) . Among the hypoxemia group( n = 84) , there were 16 patients with DVT with a prevalence of VTE of 19. 1% ( 16/84) in which 3 cases developed with PTE. In the non-hypoxemia group ( n =198) , the prevalence of VTE was 0. 5% ( 1/198) , and there was no case with PTE. The incidence of VTE in the hypoxemia group was significantly higher than that in the non-hypoxemia group( P lt; 0. 01) .Logistic analysis showed that lower PaO2 was the risk factor for VTE ( P lt; 0. 01 ) . Conclusions The incidence of VTE in AECOPD was 6% , mainly in the form of lower limb DVT. Hypoxemia was the risk factor for VTE in patients with AECOPD.
Objective To invesitgate the prevalence of pulmonary thromboembolism （PTE） in hospitalized patients with obstructive sleep apnea-hypopnea syndrome （OSAHS）from January 2004 to December 2008，and analyse its impact on the severity of OSAHS. Methods Demographic and clinical characteristics of 24 OSAHS patients complicated with PTE were analyzed. 30 OSAHS patients without PTE were served as controls. Results PTE was detected in 2.44% （31/1268） of the OSAHS patients. When compared with the OSAHS patients without PTE，the OSAHS patients with PTE had a significantly higher apnea hypopnea index （AHI） [（27.8±11.6）/h vs. （18.2±8.1）/h，P=0.038] and a lower LSpO2 （lowest saturated pulse arterial oxygen level） [（78.4±8.5）% vs. （85.2±7.9）%，P=0.035]. Both groups received continuous positive airway pressure （CPAP） ventilation. Anticoagulation and/or thrombolysis treatment were used in the OSAHS patients with PTE. Conclusions We found a higher prevalence of PTE in patients with OSAHS. Compared with those without PTE，OSAHS patients with PTE have more severe sleep apnea-hypopnea and hypoxemia in sleep. Comprehensive treatments including anticoagulation and CPAP should be used in these patients.
Objective To improve the knowledge of inflammatory bowel disease complicated with venous thromboembolism for better diagnosis and treatment. Methods One case of patient with ulcerative colitis complicated with a multiple vessel thromboembolism ( pulmonary arterial, deep vein of lower limb, and superior mesenteric vein) was analyzed, and related literatures were reviewed. Results The patient resulted in pulmonary thromboembolism ( PTE) recurrence because of irregular treatment. In addition to deep vein thrombosis of the lower extremity, a new discovery of the superior mesenteric vein embolism ( MVT) was diagnosed. The bleeding risk of heparin or lowmolecular weight heparin ( LMWH) for treatment is low, while that of warfarin is high. Conclusions Venous thromboembolism ( VTE) has a close relationship with inflammatory bowel disease ( IBD) such as ulcerative colitis. The symptomis not so typical that it is easy to misdiagnosis and missed diagnosis. It is noted that mesenteric venous thrombosis ( MVT) should be excluded in IBD patients suffering from VTE, if the source of embolus is not clear. Suitable treatment should be considered according to the risk stratification of VTE and risk-benefit ratio because of a high bleeding risk.
Objective To investigate the relation of spinal ventricular septal angle (SVSA) measured by computer tomographic pulmonary angiography (CTPA) and pulmonary vascular resistance (PVR) measured by right heart catheterization in patients with chronic thromboembolic pulmonary hypertension (CTEPH) .Methods Eighty-nine patients with CTEPH (male 57, female 32; 53.08 ±12.43 years) were recruited as a CTEPH group, and 89 patients without pulmonary artery hypertension and pulmonary embolismwere recruited as a control group. The CTEPH patients received CTPA before right-heart catheterization and pulmonary angiography. SVSA and pulmonary artery obstruction indexes including Qanadli Index and Mastora index were evaluated by two radiologists.Results SVSA was 65.13°±12.26°and 39.69°±5.84°in the CTEPH group and the control group respectively, with significant difference between two groups ( t =14.479, P = 0.000) . Qanadli index of the CTEPH patients was( 42.50 ±17.67) % , which had no correlation with SVSA ( r= 0.094, P = 0.552) . Mastora index was ( 30.02 ±15.53) % , which also had no correlation with SVSA ( r=0.025, P =0.873) . SVSA had a moderate positive correlation with PVR ( r =0.529, P =0.000) and a weak positive correlation with right atriumpressure ( r =0.270, P =0.010) . Area under ROC was 0.764 and sensitivity, specificity for PVR≥1000 dyne· s· cm- 5 was 0.714 and 0.778 respectively when SVSA≥67.55°. Conclusion SVSA measured by CTPA can be used as a better predictor for evaluating PVR in CTEPH patients.
Abstract： Objective To analyze the manifestation, treatment，outcome and potentially predisposing risk factors of perioperative thromboembolism after cavo-pulmonary connection, and to assess the effects of our prophylactic antithrombotic strategy. Methods Clinical data of 264 cases of bidirectional Glenn and 224 cases of total cavopulmonary connection （TCPC） operations undertaken from September 2005 to December 2010 in Fu wai hospital were retrospectively analyzed. Perioperative thromboembolic complications occurred in 9 patients. 5 of them were after bidirectional Glenn, 4 were after TCPC. Most of the 9 patients had at least one thrombi-related risk factor. The routine prophylactic antithrombotic therapy after these operations were intravenous infusion of heparin 10 U/（kg·h） initially, followed with oral aspirin 1-3 mg/（kg·d）. Results Thromboembolic events occurred within 7 days after the operation in 6 cases, appeared 2 to 4 weeks after the surgery in 3 cases. All 9 patients received anticoagulation with heparin. One patient also undertook take-down operation. 3 （33%） patients died, accounting for 33% （1/3）, and 18% （2/11） of the early deaths after bidirectional Glenn and TCPC operations. Clinical symptoms improved or disappeared in the remaining 6 patients. Conclusion The mortality of perioperative thromboembolic complications after cavo-pulmonary connection is high, consisting of the important cause of early deaths after these procedures. Our prophylactic anticoagulation strategy proved to be effective, though some thrombi-relatedrisk factors still need to be avoided.
Abstract: Objective To investigate the clinical features, differential diagnosis, surgical treatment and outcome of primary pulmonary artery sarcoma. Methods Between January 1994 and December 2004, 5 patients with primary pulmonary artery sarcoma were identified at operation and treated by surgical resection. Pulmonary valve stenosis were initially diagnosed in 3 patients, and chronic pulmonary embolism were initially diagnosed in 2 patients. Tumor resection from the vascular bed was performed in 1 patient and tumor resection and homograft reconstruction of pulmonary arteries were performed in 4 patients. Results One patient died of postoperative refractory pulmonary hypertension, 2 patients died 4 months after operation because of brain metastases, 1 patient was alive for 9 months after operation with recurrent pulmonary tumor, and 1 patient was alive for 2 years after operation without clinical or radiological signs of tumor recurrence or metastasis. Histological examinations showed 4 malignant mesenchymomas and 1 fibrosarcoma. Conclusions Primary pulmonary artery sarcomas are rare and usually fatal tumors of the cardiovascular system. The diagnosis is difficult and this disease is frequently misdiagnosed as chronic pulmonary hromboembolism and pulmonary valve stenosis. Early diagnosis can be improved by computerized tomography scanning and magnetic resonance imaging. Radical surgical resection was the most effective modality for shortterm palliation. The prognosis of pulmonary artery sarcoma is poor. The survival time after resection varies from several months to several years depending on the presence of recurrence or metastasis.