分析我院近10年肺栓塞(PE)诊治现况，探讨科室间对PE的诊治差异。

分析2006年01月至2015年10月出院诊断为PE的患者资料，调查PE病例数、首诊科室、诊断方法；分析确诊PE患者的高危因素、临床表现、辅助检查(心电图、心脏彩超、心肌酶谱、肌钙蛋白、脑钠肽、下肢血管彩超、D-二聚体、动脉血气)、抗凝药物、抗凝开始时间、误诊以及转归等。

①共375例患者诊断为PE(确诊231例、临床诊断144例)，CT肺动脉造影为确诊PE的主要方法[诊断221例(95.67%)]；随年限增加，PE病例数逐年增加，其中呼吸内科、心血管内科、普外科和急诊科为诊断较多的前四位科室(分别为36.80%、23.81%、17.75%和8.23%)；确诊PE患者死亡8例(3.46%)，24例(10.39%)自动出院/转院；确诊PE首诊时误诊率为10.39%(24例)；②确诊PE患者前三位临床表现是呼吸困难(77.49%)、咳嗽(35.93%)和下肢肿胀(35.93%)；③确诊PE前四位危险因素是卧床(20.35%)、癌症(16.02%)、深静脉血栓形成史(9.96%)和骨科术后(9.52%)；④确诊PE患者中186例(80.52%)给予低分子肝素治疗，32.03%患者确诊后第1天开始LMWH治疗；163例(70.56%)予华法林治疗；24例(10.39%)仅给予对症处理；出院时77例(33.33%)国际标准化比值达2～3；⑤呼吸科与其他科室比较：D-二聚体(χ²＝4.025，P＝0.045)、动脉血气(χ²＝5.953，P＝0.015)、心电图(χ²＝5.682，P＝0.017)和出院时患者INR达2～3执行情况(χ²＝26.143，P<0.001)优于其他科室，但心脏超声(χ²＝2.153，P＝0.142)、脑钠肽(χ²＝0.019，P＝0.891)、心肌酶谱(χ²＝1.357，P＝0.244)、肌钙蛋白(χ²＝1.772，P＝0.183)、下肢血管彩超检查(χ²＝0.722，P＝0.395)、对症处理(χ²＝0.670，P＝0.413)、确诊后第一天华法林抗凝(χ²＝1.417，P＝0.234)、确诊后第一天LMWH抗凝(χ²＝3.362，P＝0.067)、确诊后肝素与华法林同日重叠抗凝(χ²＝3.482，P＝0.062)并不优于其他科室。

PE患者高危因素多、临床表现不典型；我院临床医师对PE的诊断意识有增加，但辅助检查和危险分层意识尚较差，治疗水平尚有待提高。

To analyze the diagnosis and treatment of pulmonary embolism (PE) in our hospital in recent 10 years, and to understand the difference among different departments in the process.

Through analyzing the clinical data of discharge diagnosis with PE in patients betweenJanuary 1, 2006 and October 1, 2015, these clinical indexes of discharge patients with PE, such as the cases number, the first consultation department, diagnostic methods, and these clinical indexes of confirmed patients with PE, such as risk factors, clinical manifestation, electrocardiogram, echocardiography, myocardial enzymes, troponin, brain natriuretic peptide, lower extremity vascular ultrasound, D-dimer examination, arterial blood gas analysis, vascular ultrasound examination of lower extremity, anticoagulant, the start time of anticoagulation, misdiagnosis and the prognosis were investigated.

①the number of PE cases increased year by year, and a total of 375 cases of patients were diagnosed with PE including 231 confirmed cases and 144 cases with clinical diagnosis. Two hundred and twenty-one confirmed cases(95.67%)were diagnosed by computed tomography pulmonary angiography that was the main method for the diagnosis of PE in our investigation. Among which the top four diagnosis departments of PE were respiratory department, cardiovascular department, general surgery and emergency department (36.80%, 23.81%, 17.75% and 8.23%, respectively). There were 8 cases of death (3.46%), 24 cases of automatic discharge/transfer (10.39%) and 24 cases of misdiagnosis (10.39%) in the confirmed patients with PE. ②the clinical manifestation of confirmed patients with PE in the top three were dyspnea (77.49%), cough (35.93%) and lower limb swelling (35.93%), respectively. ③the risk factors of confirmed patients with PE in the top four were in bed (20.35%), cancer (16.02%), medical history of deep venous thrombosis (9.96%) and post-operation of orthopedics (9.52%), respectively. ④of these confirmed patients with PE, 24 cases (10.39%) were only given symptomatic treatment, 80.52% were treated with low molecular weight heparin (LMWH) and 70.56% were given therapy of warfarin, but only 32.03% were treated with LMWH at the first day of diagnosis and the international normalized ratio (INR) of 33.33% discharge patients reached 2 to 3. ⑤when compared to other departments, there were significant differences in D-dimer examination(χ²=4.025, P=0.045), arterial blood gas analysis(χ²=5.953, P=0.015), electrocardiography(χ²=5.682, P=0.017), and the implementation of patients with INR of 2-3 at discharge in respiratory department(χ²=26.143, P<0.001). No significant differences were found in echocardiography(χ²=2.153, P=0.142), brain natriuretic peptide detection (χ²=0.019, P=0.891), myocardial enzyme examination (χ²=1.357, P=0.244), troponin assays(χ²=1.772, P=0.183), vascular ultrasound examination of lower extremity(χ²=0.722, P= 0.395), symptomatic treatment(χ²=0.670, P=0.413), anticoagulation with warfarin at the first day after the diagnosis(χ²=1.417, P=0.234), anticoagulation with LMWH at the first day after the diagnosis(χ²=3.362, P=0.067), overlapping anticoagulation with heparin and warfarin at the same day after the diagnosis(χ²=3.482, P=0.062), between respiratory department and the other departments.

In patients with PE, high risk factors are shown and the clinical features are not typical. The awareness of the diagnosis with PE in our hospital has been increasing, but the consciousness of the auxiliary examination and the risk stratification were still poor and the level of treatment need to be further improved.