肺栓塞导致的非感染性慢性阻塞性肺疾病急性加重的原因分析

Impact factors of patients with non-infection AECOPD induced by pulmonary embolism

目的分析肺栓塞引起的非感染性慢性阻塞性肺疾病急性加重(AECOPD)的影响因素,为临床诊治提供理论依据。方法回顾性分析该院收治的非感染性AECOPD的住院患者182例。将其分为肺栓塞组60例和无肺栓塞组122例。对比两组患者的一般资料、临床症状、既往病史、辅助检查结果,并通过Logistic回归分析探讨肺栓塞导致的非感染性AECOPD的危险因素。结果两组患者在年龄、嗜烟史、长期家庭氧疗史、伴胸痛、伴咯血、伴心悸、伴呼吸困难、合并高血压病史、合并冠心病病史、合并糖尿病病史、既往有静脉血栓病史、伴心房纤颤、血氧分压和血二氧化碳分压的对比,差异没有统计学意义(均P>0.05)。肺栓塞组有25.00%卧床时间超过1周,36.67%双下肢周径相差1 cm以上,28.33%血二氧化碳分压≤36 mm Hg(基线值),38.33%有深静脉血栓形成,98.33%患者D-二聚体≥500μg/L,均明显高于无肺栓塞组(均P<0.05)。Logistic回归分析显示,卧床时间超过1周、双下肢周径相差1 cm以上、有深静脉血栓形成是肺栓塞导致非感染性AECOPD的危险因素。结论长时间卧床、双下肢周径存在明显差异、有深静脉血栓形成是肺栓塞导致非感染性AECOPD的危险因素,临床上应重视肺栓塞的可能,避免发生漏诊。

[ Objective ] To investigate the impact factors of patients with non-infection acute exacerbation chron- ic obstructive pulmonary disease （AECOPD） induced by pulmonary embolism （PE） and provide reference for clinical diagnosis and treatment. [ Methods] One hundred and eighty-two patients with non-infection AECOPD in our hos- pital were retrospectively analyzed. The patients were divided into pulmonary embolism group with 60 cases and non pulmonary embolism group with 122 cases. The general information, clinical symptoms, past history, and auxiliary examination results of the two groups were compared. The risk factors of patients with non-infection AECOPD in- duced by PE were analyzed by logistic regression analysis. [ Results ] Comparison of age, smoking history, long-term oxygen therapy at home, chest pain, hemoptysis, palpitation, dyspnea, hypertension, coronary heart disease history, diabetes history, history of venous thromboembolism, atrial fibrillation, PO2, PC02 between the two groups, the differ- ences were not statistically significant （P 〉0.05）. In the pulmonary embolism group, 25% cases with more than 1 weeks time in bed, 36.67% cases with limb circumference more than 1 cm, 28.33% cases with PC02≤36 mmHg （baseline value）, 38.33% cases with deep venous thrombosis, and 98.33% cases with D Dimer≥500 μg/L, which were significantly higher than those of non pulmonary embolism group （P 〈0.05）. Logistic regression analysis showed that, the time in bed for more than one week, lower limbs circumference more than lcm, with deed venous thrombosis were risk factors of PE in patients with COPD exacerbations of unknown origin. [ Conclusion ] Long time in bed, different lower limbs eircumterenee, deep venous thrombosis are risk factors of patients with non-infection AECOPD induced by PE. PE should be paid attention to avoiding missed diagnosis.