Clinical Analysis Of Patients With Chronic Thromboembolic Pulmonary Hypertension

Objective Analyze the clinical characteristics of patients with chronic thromboembolic pulmonary hypertension(CTEPH)to improve clinicians’ understanding of CTEPH,early intervention and treatment,improve the quality of life of patients,and reduce mortality.Methods The clinical data of 64 CTEPH patients were retrospectively analyzed,including general information,related underlying diseases,symptoms and signs,auxiliary examinations,treatment plans,and statistical analysis.Results 1.The average diagnosis and onset time of 64 patients in this group was22.01±14.14 months,of which 20 were males,44 were females,the male to female ratio was1:2.2,the age range was 29-86 years old,and the average age was 66.62±10.71 The age group with the largest number of patients is 60-79 years old,with 43 people(67.1%).2.The incidence of main symptoms and signs in the CTEPH case group: exertional dyspnea(93.7%),fatigue(70.3%),edema of both lower extremities(50%),rapid breathing>20 breaths/min(87.5%);WHO The proportions of functional grades I to IV were 14.06%,15.6%,17.18% and 53.12%,respectively.3.The underlying diseases of CTEPH: 62 cases(96.8%)of CTEPH patients with a history of deep vein thrombosis.4.Laboratory inspection:4.1 The NT-pro BNP level of this group of CTEPH patients increased significantly.4.2 Blood gas analysis: The patients in this group of patients all had different degrees of hypoxemia,of which 35 cases(54.6%)had Pa O2<60mm Hg,21 cases(32.8%)had Pa CO2≤35mm Hg,and 33 cases had Pa CO2≥45mm Hg(51.5%),48 cases(75%)had increased alveolar-arterial oxygen partial pressure difference.4.3 D-dimer: 64 patients were tested for D-dimer,of which 58 were positive(90.6%).4.4 Echocardiography: The average PASP of this group of CTEPH patients is63.32 mm Hg,and the value range is between 38-107 mm Hg.4.5 CTPA: CTPA showed that all patients in the CTEPH case group had pulmonary artery thromboembolism.According to CTPA,the patients were classified into type Ⅰ-Ⅲ,of which type Ⅰ(65.6%)was the most common,and most of the thrombus was mural thrombus.4.6 Lower extremity vein examination: All CTEPH patients underwent lower extremity vascular ultrasound examination,of which 62 cases(96.8%)were positive.5.The basis of treatment for all patients was warfarin for long-term anticoagulation.There were 48 cases(75.0%)of non-standardized anticoagulation treatment,and treatment compliance was poor.Conclusion 1.CTEPH patients are more common in elderly patients,and the main risk factor is deep vein thrombosis of the lower extremities.2.The symptoms and signs of CTEPH are non-specific,and are more common with exertional dyspnea and fatigue.Most of them are late at the time of diagnosis,and heart function involvement is common in grade III/IV(NYHA cardiac function).Echocardiography is an important non-invasive examination and disease evaluation method for diagnosing CTEPH.Plasma N-terminal pro-brain natriuretic peptide is a reliable indicator reflecting the impaired right heart function in patients with CTEPH.3.CTPA examination revealed that pulmonary artery thrombosis was mainly type I(embolism of the main pulmonary artery,left and right pulmonary arteries and lobe arteries),and the most common form of thrombus was mural thrombosis.4.The basic treatment of CTEPH is anticoagulation.If there is no contraindication,anticoagulation should be used for life.Unstandardized long-term anticoagulation is the main factor for CTEPH.