分析骑跨型肺栓塞的临床特征并与左右肺动脉干栓塞进行比较。

回顾性分析2011年8月至2015年2月浙江大学医学院附属邵逸夫医院及宁波市第一医院17例骑跨型肺栓塞患者的临床资料。将17例骑跨型肺栓塞症患者纳入骑跨组，同期选择96例左右肺动脉主干肺栓塞患者为非骑跨组。对两组患者的高血压史、3个月内手术或创伤史、脉搏、收缩压、舒张压、休克或低血压发生比例、D-二聚体、肌钙蛋白Ⅰ、血氧分压、氧合指数、N末端脑钠肽前体（NT-proBNP）、右心功能不全发生比例及右室收缩压水平进行比较。同时进行出院随访，记录两组患者3个月全因病死率。

骑跨组与非骑跨组患者主要临床症状均为呼吸困难（12/17 vs. 74/96）、咳嗽（6/17 vs. 20/96）、胸痛（5/17 vs. 15/96）及晕厥（5/17 vs. 17/96），但两组比较差异均没有统计学意义（χ² = 0.335、1.705、1.885、1.262，P = 0.563、0.192、0.170、0.261）。两组间各指标比较，仅骑跨组患者3个月内手术或创伤史（6/17 vs. 9/96，χ² = 8.428，P = 0.004）及血氧分压水平[（89 ± 25）mmHg vs.（79 ±25）mmHg，t = 2.002，P = 0.045]显著高于非骑跨组。全部患者均住院治疗，无住院死亡病例。骑跨组3个月全因死亡例数为0，而非骑跨组为2例。

骑跨型肺栓塞患者短期预后不劣于肺动脉主干肺栓塞患者，对此类患者可根据肺栓塞危险分层而非是否骑跨给予相应治疗。

To evaluate the clinical characteristics of patients with saddle pulmonary embolism (SPE) and its comparison with left and right main pulmonary artery embolization.

The clinical data of 17 patients with saddle pulmonary thromboembolism from August 2011 to February 2015 were retrospectively analyzed. And 96 patients with pulmonary embolism in right and/or left pulmonary artery were enrolled as the non-SPE group. The hypertension, surgery or trauma within 3 months, pulse, systolic blood pressure, diastolic blood pressure, shock or hypotension, D-dimer, serum cardiac troponin Ⅰ, partial pressure of blood oxygen, oxygenation index, N-terminal pro-brain nitric peptide, right ventricular dysfunction and right ventricular systolic blood pressure were compared between the two groups. Meanwhile, the death cases in 3 months were recorded during the follow-up.

The main clinical symptom in the SPE group and non-SPE group were dyspnea (12/17 vs. 74/96), cough (6/17 vs. 20/96), chest pain (5/17 vs. 15/96) and syncope (5/17 vs. 17/96), and there were no siginificant differences among the above symptoms (χ² = 0.335, 1.705, 1.885, 1.262; P = 0.563, 0.192, 0.170, 0.261). And in the SPE group, the surgery or trauma within 3 months (6/17 vs. 9/96, χ² = 8.428, P = 0.004) and partial pressure of blood oxygen [(89 ± 25) mmHg vs. (79 ± 25) mmHg, t = 2.002, P = 0.045] were much higher than those in the non-SPE group. All patients were hospitalized and no patient died during the hospitalization. Two cases in the non-SPE group died of pulmonary embolism, but no case died in the SPE group within 3 months.

The short-term prognosis of patients with saddle pulmonary thromboembolism is not inferior to that of patients with pulmonary trunk embolism, and the patients can be treated according to the risk stratification of pulmonary embolism rather than whether having saddle or not.