慢性阻塞性肺疾病急性加重合并肺栓塞的临床特征分析

Clinical characteristics of acute exacerbation of chronic obstructive pulmonary disease with pulmonary embolism

目的分析无明确感染依据的慢性阻塞性肺疾病急性加重(AECOPD)合并肺栓塞(PE)的临床特点。方法选取2011年6月至2018年11月北京核工业医院心血管呼吸内科收治的无明确感染依据的AECOPD合并PE的患者38例(A组),及同期收治的无明确感染依据的AECOPD患者60例(B组),所有入选患者均于入院12h内询问病史,体格检查,化验动脉血气分析、血浆D-二聚体,并行床边心电图。比较两组患者的临床特点,包括一般资料、既往史、现病史、体格查体及化验检查等指标。结果两组患者在慢性心力衰竭史(长期口服利尿剂)、长期卧床史(≥7d)、下肢不等粗(≥1cm)、D-二聚体水平(≥500μg/L)、动脉血气中PaCO2水平(<35mmHg)的比较中差异有统计学意义(P<0.05)。结论临床无明确感染依据的AECOPD患者出现慢性心力衰竭史、长期卧床史、下肢不等粗、D-二聚体水平、动脉血气中PaCO2下降特点时,应高度警惕是否合并PE。

Objective To evaluate and summarize the clinical characteristics of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with pulmonary embolism (PE) without clear evidence of infection. Methods 38 patients with AECOPD without clear evidence of infection complicated with PE in Cardiovascular and Respiratory Medicine of Beijing Nuclear Industry Hospital from June 2011 to November 2018 were selected as group A. Another 60 patients with AECOPD without clear evidence of infection were selected as group B. Medical history,physical examination,arterial blood gas analysis,plasma D-dimer test and bedside electrocardiogram were performed in all patients within 12 hours of admission. The clinical characteristics of the two groups were compared,including general information,past history,current history,physical examination and laboratory examination,etc. Results There were significant statistical differences ( P <0.05) between the two groups in the history of chronic heart failure (long-term oral diuretics),long-term bedridden history (>7 days),unequal thicknesses of lower limbs (>1 cm),D-dimer level (>500 μg/L) and PaCO 2 level in arterial blood gas (<35 mmHg). Conclusion The clinical features of AECOPD with PE without clear evidence of infection patients include chronic heart failure,long-term bedridden history,unequal thickness of lower limbs,D-dimer level,and decrease of PaCO 2 in arterial blood gas. When AECOPD without clear evidence of infection patients have the above clinical features in clinical work,PE should be highly suspected.