慢性阻塞性肺疾病急性加重期伴发肺动脉栓塞的发生率及其危险因素分析

Incidence and risk factors of pulmonary embolism in patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)伴发肺动脉栓塞(PE)的发生率及其危险因素。方法选择我院2015年10月至2016年11月接诊的96例AECOPD患者,按是否伴发肺动脉栓塞分为两组,观察组为26例AECOPD伴发PE患者,对照组为70例AECOPD患者。观察比较两组患者临床特征及检查结果,分析AECOPD伴发PE的发生率及其危险因素。结果两组患者咳嗽、呼吸困难、干湿性罗音及晕厥症状发生率没有较大区别,观察组发热、咯血、胸痛、胸腔积液及不对称下肢水肿症状发生率明显高于对照组,差异有统计学意义(P<0.05)。两组患者血小板压积(PCT)没有明显差异,观察组患者Pa O2、Pa CO2较对照组患者明显更低,观察组患者WBC、Hb、肺动脉压、ET-1及D-二聚体(D-D)较对照组患者明显更高,两组差异有统计学意义(P<0.05)。观察组长期卧床占65.38%,心功能不全占42.31%,既往肺血栓栓塞症史占26.92%,脑血栓意外占23.08%,恶性肿瘤占19.23%,6周内手术史占15.38%,下肢外伤史占11.54%;对照组长期卧床占14.29%,心功能不全占21.43%,既往肺血栓栓塞症史占2.86%,脑血栓意外占2.86%,恶性肿瘤占5.71%;观察组继发性危险因素发生率均比对照组更高,两组差异有统计学意义(P<0.05)。结论 AECOPD伴发PE的发生率较高,长期卧床、心功能不全及既往肺血栓栓塞症史是其主要危险因素。

Objective To investigate the incidence and risk factors of pulmonary embolism（ PE） in patients with acute exacerbation of chronic obstructive pulmonary disease（ AECOPD）. Methods All 96 cases of AECOPD patients in our hospital from October 2015 to November 2016 were collected,according to whether or not they had PE were divided into two groups.In the observation group,26 cases of AECOPD combined with PE,the control group of 70 cases of simple AECOPD patients. The clinical characteristics and results of the two groups were observed and compared. The incidence of AECOPS accompanied by PE and its risk factors were analyzed. Results There was no significant difference between the two groups in the incidence of cough,dyspnea,dry rales and syncope. The incidences of fever, hemoptysis, chest pain, pleural effusion and asymmetric lower extremity edema were significantly higher in the observation group than in the control group.The difference was statistically significant（ P〈 0. 05）. There was no significant difference in the PCT between the two groups. The Pa O2 and Pa CO2 of the observation group were significantly lower than those of the control group. The WBC,Hb,pulmonary artery pressure,ET-1 and D-D of the observation group were significantly higher than those of the control group,the difference was statistically significant（ P 〈0. 05）. The observation group in Long-term bed rest accounted for 65. 38%,cardiac insufficiency accounting for 42. 31%,previous history of pulmonary embolism 26. 92%,cerebral thrombosis accidents accounted for 23. 08% of malignant tumors accounted for 19. 23%,six weeks after surgery accounted for 15. 38%,lower extremity trauma history accounted for 11.54%; the control group accounted for 14.29% of long-term bed,heart dysfunction accounted for 21.43% of the previous lung thromboembolism history accounted for 2. 86%,cerebral thrombosis accidents accounted for 2.86%,accounted for 5.71% of malignant tumor. The incidence of risk factors in the observation group was higher than that in the control group,the difference was statistically significant（ P〈 0. 05）.Conclusion AECOPD associated with a higher incidence of PE,Long-term bed rest,Heart failure and history of pulmonary thromboembolism are the main risk factors.