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  [摘要] 目的 对经抗凝治疗的中危、低危肺栓塞患者进行随访,分析其远期预后,探讨影响 预后的危险因素。方法 回顾性收集青岛大学附属医院自2010年1月至2015年1月初次诊断的424 例非高危肺栓塞患者住院及门诊随访资料,电话随访患者出院后华法林应用情况、监测情况及临床转 归,探讨其远期预后 (死亡、再发深静脉血栓、慢性血栓栓塞性肺动脉高压和/或右心衰竭、抗凝后引 起出血)差别并分析导致不良预后的危险因素。结果 随访424例中、低危肺栓塞患者,为期1.0~ 5.5年,失访41例,死亡65例。不同危险分层非高危肺栓塞患者远期预后差异有统计学意义 (H = -5.261,P <0.05);不同危险分层间死亡、慢性血栓栓塞性肺动脉高压、出血及再发深静脉血栓差 异有统计学 意 义 (P 值 均 <0.001)。多 因 素logistic回 归 分 析 显 示 年 龄 (OR =1.029,95% CI : 1.008~1.049)、恶性肿瘤 (OR =6.300,95%CI :2.906~13.658)、右心功能不全 (OR =4.058, 95%CI :2.482~6.635)、隐源性肿瘤 (OR =22.667,95%CI :2.298~223.537)为影响长期预后 的危险因素。结论 非高危肺栓塞患者预后存在差异。高龄、恶性肿瘤、右心功能不全及隐源性肿瘤 可能是影响非高危肺栓塞患者不良预后的主要危险因素。

  [Abstract] Objective Toevaluatethelong-termoutcomeandtherelatedfactorsofsub-massive pulmonaryembolismafteranticoagulation.Methods Clinicaldataandtheclinicfollow-updataof424 casesdiagnosedasnon-high-riskpulmonaryembolismfromJanuary2010toJanuary2015intheAffiliated HospitalofQingdaoUniversitywerecollected.Telephonefollow-upwasmadetoinvestigatethewarfarin medication,monitoring statusand clinicaloutcomes.Closeattention was paidto clinicaldata,risk stratification and the clinical events,including death,recurrent thromboembolic events,chronic thromboembolicpulmonary hypertension,bleedingcomplicationsattributedtoanticoagulanttherapy. Singleand multiplefactorlogisticregressionanalysiswereperformedtoexploretheriskfactorsthat mightaffectthelong-termprognosis.Results 424patientswereretrospectivelyreviewedandfollowedup for1.0-5.5yearswith41droppingoutand65deaths.Theresultshowedthatintermediate-highrisk, intermediate-lowriskandlow risk pulmonaryembolism hadadifferentlong-term outcome(H = -5.261,P <0.05).There weresignificantdifferencesindeath,chronicthromboembolicpulmonary hypertension,bleedingandrecurrentthromboembolicamongdifferentriskstratifications(allP <0.001). Multivariatelogisticregression analysisrevealedthatage(OR =1.029,95% CI :1.008-1.049), malignanttumor(OR =6.300,95% CI :2.906-13.658),rightventriculardysfunction(OR =4.058, 95%CI :2.482-6.635)andoccultcancer(OR =22.667,95% CI :2.298-223.537) wereriskfactors affectingthelong-term prognosis.Conclusions Thelong-term outcomediffersamongdifferentrisk stratificationsofnon-high-riskpulmonaryembolism.Age,malignanttumor,rightventriculardysfunction andoccultcancermaybetheriskfactorsaffectingthelong-termprognosisinpatientswithnon-high-risk pulmonaryembolism.

  [关键词] 非高危肺栓塞;抗凝;远期预后;危险因素

  [Key words] Non-high-risk pulmonaryembolism;Anticoagulation;Long-term prognosis;Risk factors

  [中图分类号]

  [DOI] 10.3760/cma.j.issn.1673-436X.2017.04.008

  [基金项目]

  [作者简介]

  [作者单位] 青岛大学医学院 (许明玲);266000 青岛大学附属医院崂山院区呼吸科 (程兆忠、王丽君、 邵艳梅)

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