| Purpose The risk factors, clinical features and relevant important auxiliary examinations of AECOPD (Acute exacerbation of Chronic obstructive pulmonary disease) and PTE (Pulmonary thromboembolism) were studied to improve the diagnostic rate and reduce the mortality rate. Method The hospitalized cases with CTPA examination of Cadre Treatment Department of The Second Affiliated Hospital of Kunming Medical University from January 2011 to March 2014 were collected, in which 55 inpatients that conformed to the diagnostic criteria of AECOPD and PTE were set as the case group (AECOPD+PTE group) and 55 inpatients that had no PTE after CTPA examination and confirmed to the diagnostic criteria of AECOPD were set as the control group (pure AECOPD group). The following indexes of the patients of the two groups were compared:1. Risk factors of thrombosis:age, sex, smoking history, history of venous thrombosis, cardiac insufficiency, hypertension, diabetes, cancer history and history of bed rest (≥7d).2. Clinical symptoms.3. Important auxiliary examinations:FIB, DD, Hcy, ECG, arterial blood gas analysis, cardiac color ultrasound, ultrasonic Doppler of double lower extremities. SPSS 17.0 statistical software was used for the statistical analysis of the results. Results 1. Risk factors of thrombosis:the incidence rate of the case group (AECOPD+PTE group) in terms of the history of venous thrombosis, cancer history, long-time bed rest (≥7d) was higher than the control group (pure AECOPD group) and the two groups had significant statistical difference (P<0.05); the two groups had no significant difference in terms of age (≥65), smoking history, hypertension and diabetes history(P>0.05).2. Clinical symptoms:the two groups had significant statistical difference in terms of the incidence rate of syncope, asymmetric swelling of lower limbs and deep venous thrombosis (P<0.05); but the two groups had no significant difference in terms of dyspnea, chest pain, hemoptysis and cough(P>0.05).3. Auxiliary examinations: ①ABG:in the ABG analysis, paO2 of the case group (AECOPD+PTE group) was (58.7127± 11.2462) mmHg and that of the control group (pure AECOPD group) was (57.9364±10.7781)mmHg, the two groups had no statistical difference (t=-0.370, P>0.05); PaCO2 of the case group (AECOPD+PTE group) was (32.7312±6.2514)mmHg and that of the control group (pure AECOPD group) was (39.7273 ± 10.5114) mmHg, the two groups had significant statistical difference (1=4.243, P<0.05). ② Hcy:the homocysteine of the case group (AECOPD+PTE group) was (23.4661±12.2073) umol/l and that of the control group (pure AECOPD group) was (18.7145 ± 7.0950)umol/l, the two groups had significant statistical difference (t=-2.790, P<0.05). ③ DD:the DD level of the case group (AECOPD+PTE group) was (6.7073 ±8.1181)ug/ml and that of the control group (pure AECOPD group) was (2.3492±3.1496)ug/ml, the two groups had significant statistical difference (t=-3.712, P<0.05). ± DD+FIB:the patients of the case group (AECOPD+PTE group) with abnormal DD and FIB accounted for 60% and that of the control group (pure AECOPD group) accounted for 33%, the two groups had significant statistical difference (x2=8.2253, P<0.05). ⑤ ECG:in the case group (AECOPD+PTE group),35 patients (63.6%) had sinus tachycardia,39 patients (70.9%) had incomplete right bundle branch block, and 10 patients (18.2%) had typical S I QⅢTⅢ syndrome (ECG promotion, I lead, S wave, Ⅲ lead, Q-wave significance and T-wave inversion); in the control group (pure AECOPD group),23 patients (41.8%) had sinus tachycardia,29 patients (52.7%) had incomplete right bundle branch block, and 2 patients (3.6%) had typical S I QⅢTⅢ syndrome (ECG promotion, I lead, S wave, Ⅲ lead, Q-wave significance and T-wave inversion), the two groups had significant statistical difference (x2=5.2522,3.8523 and 5.9861, P<0.05); in the case group (AECOPD+PTE group),15 patients (27%) had complete right bundle branch block, and 12 patients (21.8%) had P-pulmonale; in the control group (pure AECOPD group),13 patients (23.6%) had complete right bundle branch block, and 14 patients (25.4%) had P-pulmonale, the two groups had no statistical difference (x2=0.1923 and 0.2014, P>0.05). ⑥ Ultrasonic cardiogram:30 patients of the case group (AECOPD+PTE group) were found right atrium enlargement and right ventricle enlargement and 11 patients of the control group (pure AECOPD group) were found right atrium enlargement and right ventricle enlargement, the two groups had significant statistical difference (x2=14.6791, P<0.05).42 patients of the case group (AECOPD+PTE group) had increased pulmonary artery pressure and 34 patients of the control group (pure AECOPD group) had increased pulmonary artery pressure, the two groups had no significant difference (x2=2.7242, P>0.05).45 patients of the case group (AECOPD+PTE group) had declined left ventricle diastole function and 48 patients of the control group (pure AECOPD group) had declined left ventricle diastole function, the two groups had no significant difference (x2=0.6261, P>0.05). ⑦ Ultrasonic Doppler of double lower extremities:20 patients (36.3%) of the case group (AECOPD+PTE group) had deep venous thrombosis (DVP) and 6 patients (10.9%) of the control group (pure AECOPD group) had deep venous thrombosis, the two groups had significant statistical difference (x2=8.1253, P<0.05).Conclusion:1. AECOPD patients are the high-risk group of PTE and AECOPD patients easily have PTE in case of one of the following circumstances:①DVP history, ② cancer history, ③ long-time bed rest (≥7d) and ④ male patients.2. AECOPD and PTE patients have no special clinical manifestations. In case of one of the above-mentioned risk factors, accompanied with syncope and asymmetric swelling of lower limbs, the patient may have PTE.3. When AECOPD patients have severe clinical symptoms, PaCO2 in ABG reduces, electrocardiogram has typical SIQⅢTⅢ and incomplete right bundle branch block, DD rises and FIB rises or Hcy rises, attention should be paid to the occurrence of PTE and CTPA should be conducted for confirmation. |
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