慢性肺源性心脏病合并肺血栓栓塞41例临床分析

Clinical analysis of 41 cases chronic pulmonary heart disease complicating pulmonary thromboembolism

目的探讨慢性肺源性心脏病(CPHD)合并肺血栓栓塞症(PTE)患者的临床特点。方法选择住院治疗的CPHD合并PTE患者41例(CPHD+PTE组),并选择同期住院治疗的CPHD患者38例(CPHD组),比较两组患者的临床症状及体征、血浆D-二聚体水平、PaO2变化情况。结果 CPHD+PTE组患者的咳嗽、咳痰、呼吸困难、肺部干湿啰音等临床症状和体征发生率与单纯CPHD患者比较,差异无统计学意义(P>0.05);但两组患者顽固性右心衰竭及双下肢不对称性水肿发生率差异有统计学意义(P<0.05)。两组患者经常规治疗后血浆D-二聚体水平、PaO2与治疗前比较,差异均有统计学意义(P<0.05)。结论对于CPHD患者无法用原发病解释的顽固性右心衰竭、低氧血症、血浆D-二聚体的升高,尤其是出现双下肢不对称水肿等临床表现,应高度警惕合并PTE的可能性。

Objective To investigate the clinical features of chronic pulmonary heart disease（CPHD） complicating pulmonary thromboembolism（PTE） caused by chronic obstructive pulmonary disease（COPD）.Methods Thirty-eight patients with CPHD（CPHD group） and 41 patients with CPHD combined with PTE（CPHD＋PTE group） caused by COPD were enrolled to compare retrospectively their clinical symptoms,physical signs,level of D-dimer and PaO2.Results The incidence of refractory right congestive heart failure,dissymmetry edema of both lower extremities,levels of D-dimer were significantly higher in CPHD＋PTE group than in CPHD group,but hypoxemia was significantly lower（P0.05）.Conclusion In CPHD patients,the possibility of CPHD combined with PTE should be paid special attention to,when there appear such clinical symptoms as refractory right congestive heart failure,hypoxemia and increased serum D-dimer,especially dissymmetry edema of both lower extremities,which are hard to explain according to primary diseases.