急性肺动脉栓塞早期筛查在慢性阻塞性肺病急性加重的应用

Early screening for acute pulmonary embolism in patients with AECOPD

目的探析急性肺动脉栓塞早期筛查方法,进一步评价其在慢阻肺急性加重期并急性肺动脉栓塞(APE)中的应用价值。方法筛选于我院呼吸内科、急诊内科收治的慢阻肺急性加重期疑似合并急性肺动脉栓塞患者198例,患者均行CT肺动脉造影(CTPA)检查,采集患者临床症状,包括:胸痛、咯血、呼吸困难、晕厥等,选择血浆D-二聚体、修正Geneva量表作为急性肺动脉栓塞早期筛查方法,同时分析二者相结合测定筛查的效果及可行性,与CTPA确诊的结果进行比较分析。结果 CTPA确诊50例APE,主要症状比较,单纯慢阻肺急性加重期组与慢阻肺急性加重期合并APE组间差异性明显且统计学有意义(P<0.05),体征方面比较,肺部干湿啰音、发热无显著差异性,统计学无意义(P>0.05),但不对称下肢水肿统计学差异显著(P<0.05),修正Geneva量表高可能性阳性预测值为(76.00%),低可能性阴性预测值(92.94%);血浆D-二聚体阴性预测值为95.70%,阳性预测值仅为43.81%,灵敏度92.00%,特异度为60.14%。两种筛查方法结合的阳性预测值为(50.75%),阴性预测值为(95.70%)。结论慢性阻塞性肺疾病急性加重期合并APE诊断中,予以早期筛查具有重要意义,血浆D-二聚体与修正Geneva量表结合检测,可以降低APE漏诊率,提高诊断的准确率,临床有借鉴及推广价值。

Objective To explore the early screening method for acute pulmonary embolism, and to evaluate its value in AECOPD patients complicated with acute pulmonary embolism （APE）. Methods 198 AECOPD pa- tients suspected complicated with acute pulmonary embolism were given CT pulmonary angiography （CTPA） examina- tion, and their clinical symptoms were observed, including chest pain, hemoptysis, dyspnea, and syncope. It select- ed plasma D-dimer and amended Geneva scale as acute pulmonary embolism early screening methods, and the effect and feasibility of combined screening were compared with the results of CTPA method. Results 50 cases of APE were confirmed by CTPA, and the main symptoms showed certain differences between the simple COPD group and the COPD complicated with APE group （ P 〈 0. 05 ）. There was no significant difference in lung wet and dry rales or fever （ P 〉 0. 05 ）, but asymmetric lower limb edema was significantly different between the two groups （ P 〈 0. 05 ）. The high positive predictive possibility of amended Geneva scale was 76. 00%, and its low negative predictive possibility was 92. 94%. The high positive predictive possibility of plasma D-dimer was 95.70%, and its low negative predictive possibility was only 43.81%. Its sensitivity was 92. 00%, and specificity was 60. 14%. The positive predictive value of combined screening was 50. 75% and its negative predictive value was 95.70%. Conclusion The early screening of APE has significant importance in diagnosis of AECOPD patients complicated with acute pulmonary embolism, and the combined screening of plasma D-dimer and amended Geneva scale can reduce the rate of misdiagnosis and im- prove diagnostic accuracy, which is worthy of wide clinical promotion.