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。 2010年11月； 104（11）：1744-9。
doi：10.1016/j.rmed.2010.06.006。

急性肺栓塞后劳累呼吸困难的患病率和潜在决定因素

F A Klok1，，，， K W van Kralingen，，，， A P J van Dijk，，，， F H Heyning，，，， H W Vliegen，，，， M V Huisman
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急性肺栓塞后劳累呼吸困难的患病率和潜在决定因素

F A Klok等。 Respir Med。 2010 Nov。
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Abstract

Background:The exact prevalence and etiology of exertional dyspnea in the clinical course of acute pulmonary embolism (PE) have not yet been established.

Methods:大量连续诊断为急性PE的患者接受了呼吸困难调查表，并邀请进行心肺检查，包括6分钟步行测试，肺活量测定法和超声心动图。评估了劳累呼吸困难的患病率，严重性，决定因素和潜在疾病。

结果：Of the registered 877 patients, 259 (30%) had died and 11 (1.3%) were excluded for geographical reasons. From the remaining 607 patients, 217 reported exertional dyspnea (36%; 95% CI 32-40%) 3.6 ± 1.7 years after the PE. In 76% this dyspnea had developed or worsened after the acute PE. 421 patients completed the cardiopulmonary work-up. Cardiopulmonary comorbidity (OR 12; 95% CI 6.5-20), advanced age (OR 1.02 per year; 95% CI 1.01-1.03), higher BMI (OR 1.06 per kg/m(2); 95% CI 1.01-1.1) and a smoking history (OR 1.6; 95% CI 1.02-2.6) were identified as independent predictors of exertional dyspnea. A pre-defined dyspnea explaining diagnosis could be established in all patients with exertional dyspnea. In only 4 patients, this diagnosis was directly correlated to the acute PE. Increased severity of dyspnea was associated with decreased exercise performance (p < 0.001) and a higher number of dyspnea-related diagnoses (p < 0.001).

Conclusion:Exertional dyspnea is a frequent symptom in the long term clinical course of acute PE. More severe dyspnea results in decreased exercise capacity and increased burden of cardiopulmonary comorbidity. This dyspnea is likely to be unrelated to the past thromboembolic event in the vast majority of patients.

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