探讨慢性阻塞性肺疾病合并肺血栓栓塞症的临床特征分析

To Investigate the Clinical Characteristics of Chronic Obstructive Pulmonary Disease with Pulmonary Thromboembolism

目的分析慢性阻塞性肺疾病合并肺血栓栓塞症的临床特征。方法选取2018年3月至2019年7月云南省大理市第一人民医院收治的40例慢性阻塞性肺疾病合并肺血栓栓塞症患者,对所有患者资料均进行分析,总结该病的临床特征。结果患者可表现为咳嗽、呼吸困难、咯血、胸痛、发热、晕厥、血压下降、双肺有湿啰音、下肢非对称性水肿等症状;胸片可显示患者血浆D-二聚体增高、血气分析血氧分压及动脉血二氧化碳分压(PaCO2)降低、肺CT显示胸腔有积液、心电图呈S1QⅢTⅢ表现、完全性右束支传导发生阻滞、心脏彩超提示右室扩大、肺动脉压增高,经下肢血管彩超查后显示下肢发生深静脉血栓;经CTPA检查存在肺动脉充盈缺损情况。结论如患者发生双下肢不等粗、卧床时间以及深静脉血栓形成和心电图S1QⅢTⅢ和晕厥、PaCO2下降、内皮素-1水平增高以及D-二聚体水平增高和呼吸困难持续不缓解等症状,则应对患者实施及早诊断,防止发生慢性阻塞性肺疾病合并肺血栓栓塞症。

Objective To analyze the clinical features of chronic obstructive pulmonary disease complicated with pulmonary thromboembolism.Methods From March 2018 to Jully 2019,40 patients with chronic obstructive pulmonary disease and pulmonary thromboembolism were selected from the first people's Hospital of Dali City,Yunnan Province.The data of all patients were analyzed and the clinical characteristics of the disease were summarized.Results The patients could show cough,dyspnea,hemoptysis,chest pain,fever,syncope,blood pressure drop,two lungs with dural sound,lower extremity asymmetric edema and other symptoms.Chest films can show increased plasma D-dimer,blood gas analysis of blood oxygen partial pressure and PaCO2 reduction,lung CT showed pleural effusion,electrocardiogram showed S1QIIIT III performance,complete right bundle branch conduction block,heart color super-prompt right ventricular expansion,increased pulmonary arterial pressure,Deep venous thrombosis occurred in lower extremities after the blood vessel color examination.Pulmonary artery filling defect was detected by CTPA.Conclusion If the patient has symptoms such as unequal thickness of two lower limbs,bed time,deep venous thrombosis and electrocardiogram S1QIIIT III and syncope,decreased PaCO2,increased endothelin-1 levels,and increased D-dimer levels and persistent dyspnea,The early diagnosis should be carried out to prevent the occurrence of chronic obstructive pulmonary disease and pulmonary thromboembolism.