支气管扩张症合并肺血栓栓塞症临床分析

Clinical analysis of 4 patients suffering from bronchiectasis combined with pulmonary embolism

目的:总结支气管扩张症合并肺血栓栓塞症(PE)患者的临床特点。方法:选择首都医科大学附属北京安贞医院呼吸与危重症医学科自2016年1月至2018年12月间收治的支气管扩张症合并PE的患者4例,回顾性分析4例患者的临床症状和体征、影像检查资料、实验室检查结果、超声心动图结果、治疗和转归等。所有患者进行NHYA分级、mMRC量表评分及支气管扩张症严重指数(BSI)评分。结果:4例患者均为女性,支气管扩张症病史超过20年,合并PE前2周内具有急性下呼吸道感染病史,未同时发现下肢深静脉血栓。所有患者均存在不同程度的低氧血症,对比实测值及根据年龄预测的氧分压低限值(P=0.0011,t=5.896),进一步计算D(A-a)O2并与年龄预计值比较,发现前者明显高于后者,差异有统计学意义(P=0.0062,t=4.122)。UCG所测右心房线性指数>3.1 cm/m2且sPAP>50 mmHg(1 mmHg=0.133 kPa)的患者,预后不佳。结论:支气管扩张症患者日常多有运动相关呼吸困难,与PE症状具有重叠性,容易造成临床误诊。基础右心功能不全的患者生活质量差,预后不良。

Objective:To explore the clinical features of bronchiectasis combined with pulmonary embolism(PE).Methods:Four patients were diagnosed of PE on the background of bronchiectasis in Beijing Anzhen Hospital,Capital Medical University from January 2016 to December 2018.General information,clinical manifestations,medical imaging result,laboratory tests,therapy and prognosis were analyzed retrospectively.Laboratory tests include coagulation function,B type brain natriuretic peptide,and arterial blood gas analysis,which are used to calculate the difference between alveolar oxygen pressure and arterial blood oxygen pressure.Results:There were 4 females aged from 52 to 66 years old.All patients have suffered non-cystitis bronchiectasis for more than 20 years.Before they were diagnosed as PE,they all admitted to hospital due to acute respiratory track infection within two weeks.As far as the function of right heart is concerned,there may be some relationship between BSI scale and the risk of PE.However,all patients had hypoxemia.Their arterial oxygen pressure were lower than the predicted value according to age(t=5.896,P=0.0011).The gradient of P(A-a)O2 calculated was higher than the predicted value significantly(t=4.122,P=0.0062).Patients with server heart failure have poor prognosis.Conclusions:It is more likely to experience exertional dyspnea among the patient suffered from PE,which is associated with the degree of heart dysfunction.And it is fact that such patient is hypoxemia.Right atrial liner dimension index is an available option to follow such patient.