慢性阻塞性肺疾病急性加重期伴发肺动脉栓塞的危险因素及早期无创正压通气疗效分析

Risk factors of pulmonary embolism associated with AECOPD and analysis of the efficacy of noninvasive positive pressure ventilation

目的:分析慢性阻塞性肺疾病急性加重期(AECOPD)伴肺动脉栓塞(PE)出现的风险,并观察早期无创正压通气的临床效果。方法:98例AECOPD患者,在住院治疗期间48例患者并发PE,将其作为观察组,余患者作为对照组(50例)。按照随机数法,将观察组患者根据正压通气与否分为观察Ⅰ组(常规低流量氧气伴正压通气,24例)及观察Ⅱ组(常规低流量氧气,24例)。统计98例患者临床治疗资料,Logistics回归法分析COPD患者并发PE的相关危险因素。并比较观察Ⅰ组及Ⅱ组患者住院时间、血气分析、并发症等发生情况。结果:观察组与对照组患者在年龄≥70岁、卧床≥3 d、脑卒中史、深静脉血栓史、动脉栓塞、肺炎、肺心病、下肢水肿、血浆D-二聚体水平方面差异明显(P<0.05);而患者在高血压、糖尿病史、骨折史方面的差异无统计学意义(P>0.05)。经logistics回归分析,其中年龄≥70岁、卧床时间≥3 d、血浆D-二聚体升高、下肢水肿与患者伴发PE密切相关(均P<0.05)。治疗前,对照组患者的Pa O2水平明显高于观察Ⅰ、Ⅱ组,Pa CO2水平及肺动脉压力均明显低于观察Ⅰ、Ⅱ组(均P<0.05),观察Ⅰ、Ⅱ组之间无显著性差异(P>0.05);治疗后,3组患者的Pa O2水平均显著升高,且对照组明显高于观察Ⅰ、Ⅱ组,观察Ⅰ组明显高于观察Ⅱ组,Pa CO2水平及肺动脉压力均明显降低,且对照组明显低于观察Ⅰ、Ⅱ组(均P<0.05),观察Ⅰ组明显低于观察Ⅱ组(P<0.05)。治疗后,观察Ⅰ组与对照组的不良反应发生率无显著性差异(P>0.05),但均明显低于观察Ⅱ组(均P<0.05)。结论:对于COPD患者,卧床≥3 d、血浆D-二聚体升高、下肢水肿为伴发肺动脉栓塞的危险因素,对此类患者宜早期检查并预防PE发生。对于伴发PE的患者行早期无创正压通气治疗可获得较好临床效果,适宜临床中推广应用。

Objective： To analyze the risk of acute exacerbation of chronic obstructive pulmonary disease（AECOPD）accompanied by pulmonary embolism（PE）,and to observe the clinical effect of early noninvasive positive pressure ventilation. Methods： Ninety-eight patients with COPD were screened for research. During hospitalization,48 patients complicated with PE served as the observation group,and the remaining patients as the control group（50 cases）. Using the random number method,the patients in the observation group were subdivided into two subgroups according to the positive pressure ventilation（routine low flow oxygen and positive pressure ventilation,observation subgroup 1,n = 24） and the observation subgroup 2（routine low flow oxygen,n = 24）. The clinical data of the observation group and the control group were statistically analyzed,and the related risk factors of PE complicated by COPD were analyzed by Logistics regression analysis.The hospitalization time,blood gas analysis and complications were observed before and after treatment. Results： There were significant differences in age≥70 years,≥3 days in bed,history of stroke,deep vein thrombosis history,arterial embolism,pneumonia,pulmonary heart disease,lower extremity edema and plasma level of D-dimer between observation group and control group（P〈0. 05）,but no significant difference in hypertension,diabetes history,fracture history was found between two groups（P〈0. 05）. The logistics regression analysis revealed the age over 70 years,≥3 days in bed time and increased plasma D-dimer,and lower extremity edema were closely related to PE（P〈0. 05）. Before treatment,Pa O2 level in the control group was significantly higher,and Pa CO2 level and pulmonary arterial pressure were significantly lower in the control group than those in the observation group（P〈0. 05 for all）,but there was no significant difference between observation subgroups 1 and 2（P〈0. 05）. After treatment,Pa O2 level increased significantly in all groups,and that in the control group was significantly higher than in observation subgroups 1 and 2,and that in observation subgroup 1 was significantly higher than in the observation subgroup 2; Pa CO2 levels and pulmonary arterial pressure were significantly decreased,and those in the control group were significantly lower than those in the observation subgroups 1 and group 2（P〈0. 05）,and those in the observation subgroup 1 were significantly lower than those in the observation subgroup 2（P〈0. 05）. After treatment,there was no significant difference in the incidence of adverse reactions between observation subgroup 1 and control group（P〈0. 05）,but it was significantly lower in observation subgroup 1 and control group than that in observation subgroup 2（P〈0. 05）. Conclusions： For patients with COPD,≥3 days in bed time,increased plasma D-dimer and edema of lower extremity were risk factors of pulmonary artery embolism and early examination and prevention of PE are necessary. For COPD patients with PE,early noninvasive positive pressure ventilation can achieve better clinical results,and is suitable for clinical application.