Wang Xiaohui, Gu Zhengfeng, Zhang Lu, et al. Retrospective analysis of clinical diagnosis and treatment of pulmonary embolism in nearly ten years of Chongqing city. [J]. Journal of Chongqing Medical University 42(10):1314-1319(2017)
DOI:
Wang Xiaohui, Gu Zhengfeng, Zhang Lu, et al. Retrospective analysis of clinical diagnosis and treatment of pulmonary embolism in nearly ten years of Chongqing city. [J]. Journal of Chongqing Medical University 42(10):1314-1319(2017) DOI: 10.13406/j.cnki.cyxb.001382.
Retrospective analysis of clinical diagnosis and treatment of pulmonary embolism in nearly ten years of Chongqing city
Objective:To investigate the diagnosis and treatment of pulmonary embolism in hospitals of different medical levels in recent 10 years in order to provide evidences to improve the level of the pulmonary embolism prevention
diagnosis and treatment.Methods:The clinical data of 336 pulmonary embolism patients from 31 hospitals of different medical levels of Chongqing from January 2003 to December 2012 by convenience sampling method were investigated. The questionnaire included :the general situation
the underlying diseases and risk factors
clinical manifestations
examination findings
treatment and prognosis. Results:(1)A total of 336 patients(195 cases were confirmed
141 cases were diagnosed in clinical)of which 105 cases died.(2)The most common complicated diereses were hypertension
trauma and surgery
lung cancer
cardiac insufficiency
malignant tumor
diabetes
braking
lung infection.(3)The common symptoms were dyspnea
symptoms of deepvein
chest pain
palpitation
cough
sputum
and syncope.(4)The definite diagnose rate of un-elderly patients showed higher than that of elderly patients
the difference was significant(67.14% vs. 51.03%
P=0.003). The mortality of elderly patients was higher than that of non-elderly patients
and the difference was significant(36.60% vs. 24.29%
P=0.017).(5)The definite diagnose rate of patients who were diagnosed from 2008 to2012 was higher than patients who were diagnosed from 2003 to 2007
and the difference was significant(62.23% vs. 38.6%
P=0.000).The mortality of patients who were diagnosed from 2003 to 2007 was higher than that of patients who were diagnosed from 2008 to2012
and the difference was significant(49.12% vs. 27.34%
P=0.000).(6)The definite diagnose rate of tertiary hospitals was higher than that of second-class hospitals
and the difference was significant(59.81% vs. 31.58%
P=0.015);The difference of the mortality of between tertiary hospitals and second-class hospitals was not significant(31.01% vs. 36.84%
P=0.595).(7)The mortality of intervention group was higher than non-intervention group
the difference was significant(14.53% vs. 69.61%
P=0.000).(8)The multivariate regression analysis confirmed that the factors associated with the definite diagnose rate including the age(odds ratio:2.177
95%CI=1.356 to 3.494)
time(odds ratio:3.175
95%CI=1.720 to 5.860)
and the class of hospital(odds ratio:0.262
95%CI=0.094 to 0.728);the risk factors associated with the mortality including the time(odds ratio:1.817
95%CI=0.895 to 3.687)and untreated(odds ratio:0.078
95%CI=0.044 to 0.137). Conclusion:The consciousness of pulmonary embolism diagnosis is gradually improved for the most hospital medical staff from 2003 to 2012 in Chongqing
but the consciousness of prevention and screening high-risk patients with pulmonary embolism is poor. Tertiary hospitals mainly depend on computed tomography pulmonary angiography(CTPA)in the diagnosis of pulmonary embolism. Pulmonary embolism diagnosis mainly conduct in clinic in different medical levels hospitals
and the definite diagnose rate is low. While the definite diagnose rate of un-elderly patients is higher than that of elderly patients
and the the definite diagnose rate of tertiary hospitals is higher than that of second-class hospitals. The diagnosis and treatment of Pulmonary embolism is non-standard
and the mortality of pulmonary embolism is high. Treatment could decrease the mortality of the patient with pulmonary embolism. The ability of diagnosis and treatment of pulmonary embolism should be further improved.
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Related Institution
Department of Traditional Chinese Medicine,Children’s Hospital,Zhejiang University School of Medicine/ National Clinical Research Center for Child Health
Department of Pediatrics,The Affiliated Hospital of Nanjing University of Chinese Medicine,The First Clinical Medical College of Nanjing University of Chinese Medicine
Department of Respiratory Medicine,Children’s Hospital,Zhejiang University School of Medicine/ National Clinical Research Center for Child Health
Department of Urology,The Second Affiliated Hospital of Chongqing Medical University, The Second Affiliated Hospital of Chongqing Medical University
Department of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical University