目的：分析老年急性肺栓塞（acute pulmonary embolism,APE）患者的临床特征。方法：收集2018年1月1日至2020年12月31日上海交通大学医学院附属瑞金医院收治的APE患者临床资料,根据年龄分为老年组（≥60岁）142例和非老年组（<60岁）65例,老年组再分成老年男性组和老年女性组。比较分析老年组与非老年组、老年男性组与老年女性组患者的临床特征。结果：老年组和非老年组APE最常见危险因素均为深静脉血栓,老年组合并高血压、糖尿病、冠心病、慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）、心房颤动比例高于非老年组（均P<0.05）,合并高血压的老年患者发生APE的风险是非老年组的3.281倍。老年组及非老年组最常见的临床症状均为胸闷,老年组气促比例高于非老年组（P<0.05）。老年组D-二聚体阳性率、平均血小板体积值、肺动脉压力、肌钙蛋白I、B型脑钠肽值高于非老年组（P<0.05）。老年女性组近期手术或制动史17例（23.6%）,显著高于老年男性组（4.3%）（P=0.001）。结论：老年APE患者常合并多种基础心肺疾病,临床表现不典型、诊断困难,需识别老年患者易患肺栓塞的高危因素,密切关注临床表现并联合多种检查,综合评估,以提高对老年APE患者诊断的准确性。

Objective To analyze the clinical characteristics of elderly patients with acute pulmonary embolism(APE) and to help the individualized medical treatment of APE in the elderly and to improve the management of diseases. Methods This study retrospectively analyzed the patients with APE in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2018 to December 2020. According to age, 142 cases were divided into elderly group (≥60 years old) and 65 cases into non-elderly group (<60 years old). According to sex, the elderly patients with APE were divided into elderly male group (70 cases) and elderly female group (72 cases). The clinical information including risk factors of pulmonary embolism, clinical symptoms, laboratory tests, imaging examination, treatment and prognosis in each group were collected and analyzed using SPSS20 software. Results Firstly, the deep venous thrombosis(DVT) was the most common risk factor for APE in elderly and non-elderly. The proportion of hypertension, diabetes, coronary heart disease, chronic obstructive pulmonary disease (COPD), atrial fibrillation in the elderly group was higher than those in the non-elderly group (P<0.05). The incidence of APE in the elderly patients with hypertension was 3.281 times as much as non-elderly group. Secondly, the most common clinical symptom in the elderly and non-elderly groups was chest tightness, while the proportion of breath shortness in the elderly group was significantly higher than that in the non-elderly group (P<0.05). Thirdly, the positive rate of D-dimer, mean platelet volume, pulmonary artery pressure, troponin I and B-type natriuretic peptide were higher in elderly group than those in non-elderly group(P<0.05). Fourthly, the proportion of APE in the elderly female group(23.6%) with recent history of surgery or immobilization was higher than that in the elderly male group(4.3%)(P<0.05). Conclusions The elderly patients with APE often had multiple underlying diseases, which led to atypical clinical symptoms and difficulty to make diagnosis. Clinical diagnosis should be combined with previous medical history and related examinations to avoid misdiagnosis and missed diagnosis.