| Objective:1. Compare the clinical characters of elderly and younger patients withacute pulmonary thromboembolism (PTE) in order to find out the the features of onsetand prevalence of the embolic in the elderly, and to provide clues for improving thediagnostic rate.Methods A total of184cases of hospitalized patients with the primary diagnosis ofacute PTE in the first Affiliated Hospital of Dalian Medical University from January2012to December2014. The patients were divided into two groups: the eldergroup(age≥65years old,110cases) and the younger group(18years old≤age<65yearsold,74cases). Keep detailed records of gender, age, underlying diseases and riskfactors[including hypertension, coronary heart disease, cerebrovascular disease,pulmonary disease, diabetes, heart failure, atrial fibrillation, varicose veins or deepvenous thrombosis (DVT), smoking, trauma or surgery in recent one month, lying inbed without moving>3days, cancer, rheumatic autoimmune disease, obesity, liver andkidney dysfunction, etc], typical symptoms [including dyspnea, chest pain, cough,palpitations, syncope, hemoptysis, etc.], clinical signs[including tachypnea,tachycardia, hypotension or decreased blood pressure (systolic bloodpressure<90mmHg or a decrease below the baseline≥40mmHg), cyanosis, fever,pulmonary value second heart sound (P2) hyperfunction, leg swelling, etc.], auxiliaryexamination [arterial blood gas analysis, blood biomarkers, ECG, the embolizationshowed by CT pulmonary angiography (CTPA) or pulmonary ventilation-perfusion scan, whether coexisted with DVT and the exact location of DVT]. The dates of thetwo groups were statistically analyzed after the information completed on theregistration.Results:1. The overall incidence of underlying disease in elderly group was significantlyhigher than the younger group. Hypertension was the primary underlying disease of theelderly group (54.5%); the incidence of arterial disease such as hypertension, coronaryheart disease, cerebrovascular disease had a significant increase in elderly group (allthe P values <0.005). The incidence of atrial fibrillation in the elderly group washigher than the younger group(10.91vs2.70, P=0.04).2. Varicose veins or DVT history, smoking, trauma was the first3risk factors ofthe elderly patients, while the history of varicose veins or DVT, trauma, lying in bedwithout moving>3days was the first3risk factors of the younger patients.3. The proportion of women in the elderly group of patients was62.7%, while theproportion in younger patients group was41.9%, the gender distribution of the twogroups had a significant difference (P=0.005).4. The most common symptom of the elderly and younger group was dyspnea(75.5%vs70.3%, P=0.435). The incidence rate of Hemoptysis was higher in theyounger group than the elderly group, which had significantly statistical difference(14.9%vs3.6%, P=0.006). The proportion of the chest pain (28.2%vs31.1%, P=0.077) and "PTE triad"(0.9%vs6.8%, P=0.077) were slightly lower in the elderlypatients than the younger group, which had no significant difference between the twogroups.5. In the clinical signs, the incidence rate of fever in the younger group was higherthan the elderly group, which was statistically significant (12.2%vs3.6%, P=0.027).Other signs had no significant differences.6. In auxiliary examination, the comparison in the partial pressure of oxygen(PaO2), carbon dioxide partial pressure (PaCO2), alveolar-arterial oxygen difference(A-aDO2), and other indicators of the blood gas analysis between the elderly and the younger group had no significantly statistical difference (P values were all>0.05).The plasma D-dimer (D-dimer) increased significantly both in the two groupscompared with the normal value, but the difference was not statistically significant.The elevated proportions of the two groups in the cardiac markers of thehypersensitivity troponin (hs-TnI) and B-type natriuretic peptide (BNP) were nothighly, which also had no statistically significant difference(P>0.05). ECG signsshowed no significant difference between the two groups (P>0.05).7. The incidence of thromboembolism showed by the CTPA or the pulmonaryventilation-perfusion scan was more common in the right lung and the lower lobe. Theyounger group had more right upper lobe embolism than the elderly group(16.2%vs5.5%, P=0.016), remaining that localization of the difference between the two groupswas not statistically significant.8. The combination of DVT was significantly higher in the young than the elderlygroup(60.8%vs39.1%, P=0.004). The DVT in the right lower extremity was morecommon in the younger group compared with the elderly group(20.3%vs7.3%, P=0.009), the difference between the groups was not statistically significant in otherlocalization. The most common vein that DVT involved in the two groups waspopliteal vein, femoral vein and iliac vein in sequence.Conclusion: The survey shows that the character of the elderly patients in our hospitalwith acute pulmonary thromboembolism are as follows: the PTE is more common inwomen, the embolization is more common in the right lung and the lower lobe; oftencombined with underlying disease such as arterial disease and atrial fibrillation etc. andrare with the hemoptysis, fever, and lower extremity DVT. The laboratory tests andimaging are lack of specificity. Clinicians can improve the vigilance and diagnosis rateof the suspected cases with the above characteristics. |
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