The Comparison Of Clinical Characteristics For Pulmonary Thromboembolism In Elder Patients And Younger Patients

BackgroundPulmonary thromboembolism(PTE) is a common disorder and an important cause of morbidity and mortality, and always under diagnosis or high wrong diagnostic proportion. Consider the risk factors of pulmonary thromboembolism, it is similar to venous thromboembolism(VTE), containing primary and secondary. The later one includes fracture, trauma, surgery, malignant tumor and usage of oral contraceptives, as well as age is one of most important risk factors.With the increasing of age, the morbidity of VTE elevated obviously, about double for every 20 years. In this study, we assessed the influence of age with the process of hospital stay,clinical menifestations, accompanied diseases, lab examinations(such as D-dimer,echocardiography, CTPA, V/Q scan and Doppler for extremities) and treatment for patients who were diagnosed as PTE, just tosee if there were any differences.Objects and Methods80 patients diagnosed as PTE in Sir Run Run Shaw Hospital from March 2000 to Augest 2005 were reviewed and analyzed. There were 37 patients who were more than 60 years old, 43 patients who were younger than 60 years, so called elder group and younger group. They were diangnosed PTE from CTPA (CT Pulmonary Angiography) or V/Q (ventilation/perfusion) scans or PAA (Pulmonary Artery Angiography), and then treated via thrombolysis or anticoagulation. After preparation of clinical data of those patients, we analysed hospital stay, clinical menifestations, accompanied diseases, lab examinations (D-dimer, echocardiography, CTPA, V/Q scan and Doppler for extremities) and ways of treatment. At last, we use statistic software SPSS 13.0 to centralize all the data.ResultsTwo groups were identified for age of 60 just named elder group(37 patients) and younger group(43 patients).The hospital stay of elder patients ranged from 10 to 153, the average was 32.70± 28.58 days, for comparison,the hospital stay of younger patients ranged from 5 to 61, the average was 21.74±13.84 days ,no differences could be identified.In clinical manifestations,the most common one was chest discomfort and dyspnea.The proportion of chest pain and hemoptysis in elder group were obviously less than younger one,but in contrast of other symptoms such as cough or sputum,syncope or shock,edema of limbs,there were no differences. In accompanied diseases, there were some differences for chronic bronchitis, primary hypertension, arrhythmia, the occurrence was higher in elder patients.Otherwise, the history of venous thrombsis or varies was more in younger patients. No evidence for compared differnces of diseases as diabetes, cerebral infarction, malignant tumor or history of tauma, fracture or recent surgery.In lab examination, there was 62 patients received D-dimer test, in elder group there was 30 patients, with average level was 2.97mg/L, 32 patients in younger group and average was 2.00mg/L, there was no difference.For echocardiography and pulmonary artery systolic pressure, we tested 29 elder and 35 younger patients, the average pressure were 52.39 and 35.88 mmHg, showing importance in statistics.25 elder patients accepted CTPA and 84.0% were positive,33 younger patients accepted that exam and 87.9% were positive.In this test, we reviewed the patients with thrombosis of pulmonary arteriosus truncus, resulting there were 12 and 8 separatively, the difference was clear. 17 patients got V/Q scan and 28 patients got Doppler scan of lower extremities,with the positive ones were 16 and 8 in elder group, in yougergroup the number were27, 34, 25 and 15.In this study, 8 patients received thrombolysis therapy, the left 29 ones received simple anticoagulation therapy in elder group.In youger group, the thrombolysis therapy was 15 and simple anticoagulation therapy was 28.There were no differences.Conclusions1. The clinical manifestations of elder patients were atypical, the most commom were chest discomfort and dyspnea, in younger patients the symptoms of chest pain and hemoptysis were more.2. In elder patients who were diagnosed as PTE, there always accompanied with chronic bronchitis, primary hypertension, arrhythmia, in younger patients, the history of venous thrombsis or varies was more dangerous.3. In contrast to younger patients, the pulmonary artery pressure were higher and proportion of thrombosis in arteriosus truncus were more often in elder patients.lt means the severity and dangerous in elder PTE patients.4. The usage of thrombolysis therapy was higher in younger patients, which was related to basal performance status. So if the elder ones menifested severe PTE, the therapy should be careful.5. In total, the hospital stay was longer in elder patients,about 11 days in comparison.The resons contained more basal and comprehensive diseases,more severe condition and limited therapy. So we should pay more attention to elder PTE patients.