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급성 중증 폐색전증의 임상양상과 예후에 미치는 인자

Other Titles
 Clinical characteristics and predictors of in-hospital mortality for patients with acute major pulmonary embolism 
 박윤수  ;  하종원  ;  권기환  ;  장양수  ;  정남식  ;  심원흠  ;  조승연  ;  김성순 
 Korean Journal of Medicine (대한내과학회지), Vol.58(3) : 293-300, 2000 
Journal Title
Korean Journal of Medicine(대한내과학회지)
Issue Date
Acute pulmonary embolism ; In- hospital mortality
Background : Pulmonary embolism is a relatively common disease but may also be manifestated as a lethal disease. Most previous studies on pulmonary embolism included hemodynamically stable patients who were able to tolerate a confirmative diagnostic workup, including ventilation- perfus ion lung scan or pulmonary angiography. However, in most cases of acute massive pulmonary embolism, patients are
unstable to tolerate a confirmative diagnostic workup. Studies of only s table patients with pulmonary embolism may have a bias on evaluating the clinical course and prognos is of pulmonary embolism. Therefore, we designed a study to observe the clinical manifes tations, diagnostic methods, treatment modality, and to investigate the prognostic factors of patients with acute pulmonary embolism who present with overt or impending right heart failure using the diagnos tic criteria suggested by MAPPET study
Methods : Among 103 patients diagnosed as pulmonary embolism from 1990 to 1997, 63 patients(male/female : 21/42, mean age : 56 15) were enrolled as acute major pulmonary embolism by MAPPET' s diagnos tic criteria. Patients were included in the s tudy if they showed clinical,
echocardiographic and cardiac catheterization findings signifying acute right heart failure or pulmonary hypertension due to pulmonary embolism, together with: 1) a diagnostic pulmonary angiogram, or 2) a lung scan indicating high probability of pulmonary embolism, or 3) at least 3 of the followings : ① syncope; ② tachycardia (heart rate > 100 beats /min); ③ dyspnea or tachypnea (> 24 breaths /min or need for mechanical ventilation); ④ arterial hypoxemia (partial arterial pres sure of oxygen < 70mmHg while breathing room air) in the absence of pulmonary infiltrates on chest x- ray; ⑤ ECG signs of right heart s train.
Results : Among the 63 patients, 15 patients (23.8%) did not have an underlying disease. Eleven patients(17.5%) had malignancy, 8 patients had an operation in the recent 20 days, 6 patients had chronic pulmonary disease, 5 patients had a history of congestive heart failure and cerebrovascular accident respectively, 4 patients had a previous history of pulmonary embolism, 3 patients had vasculitis such as Behcets' disease and systemic lupus erythematosus and a history of venous thrombosis, respectively. The main clinical manifestation on the time of diagnos is was dypnea in 55 patients (87.3%), which was the most frequent, and ches t pain in 18 patients(28.6%), syncope in 10 patients(15.9%), and
tachycardia in 2 patients (3.2%). The diagnos tic methods were echocardiography(43 patients , 68.3%), lung perfusion scan(39 patients, 61.9%), ches t computed tomography(16 patients , 26.4%), pulmonary angiography(4 patients, 6.3%) and right heart catherization(2 patients , 3.2%). In order to examine deep vein thrombos is , lower extremity Duplex ultrusonography and venography were performed in 11 patients (17.5%) and
7 patients (11.1%) respectively. The overall in- hospital mortality was 38.1%(24 patients). T he factors influencing in- hospital mortality were associated malignancy(p< 0.01) and unstable vital sign(systolic blood pressure of less than 90mmHg)(p< 0.05).
Conclusion : Acute pulmonary embolism with overt or impending right heart failure is a significant lethal disease with a high in- hospital mortality. T he predictors of mortality were associated malignancy and unstable vital sign.(Korean J Med 58:293- 300, 2000)
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Seok Min(강석민) ORCID logo https://orcid.org/0000-0001-9856-9227
Kim, Jong Youn(김종윤) ORCID logo https://orcid.org/0000-0001-7040-8771
Jang, Yang Soo(장양수) ORCID logo https://orcid.org/0000-0002-2169-3112
Chung, Nam Sik(정남식)
Ha, Jong Won(하종원) ORCID logo https://orcid.org/0000-0002-8260-2958
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