Study On The Haemodynamic Changes Of Acute Pulmonary Thromboembolism

Objective:Pulmonary thromboembolism(PTE)is one of three fatal cardiovascular diseases in Western countries such as America.It is also a common disease of cardiovascular system in our country.The fatality of PTE patients untreated is 25%~30%, but the rate can decrease to 2%~10% if the patients can be diagnosed and treated in time.Its haemodynamic changes(including pulmonary hypertension,right heart failure, hypotension,shock and so on) always reflect how serious the pathogenetics condition is and affect the prognosis. The objective of this study is to research and follow up the haemodynamic changes of acute pulmonary thromboembolism patients in our hospital and analyse the influencing factors of the changes(including sex,age,risk factors,treatment and so on),in order to evaluate prognosis and guide treatment.Methods:1. The PTE patients who were treated in the Affiliated Hospital of Chengde Medical College from January 2009 to September 2014 excluding the patients who had been diagnosed pulmonary hypertension(including chronic thromboembolic pulmonary hypertension) before,combined chronic heart failure,immunological disease,liver cirrhosis and other various reasons caused pulmonary hypertension or affect right heart function were enrolled in this study.2. Setting up person document for PTE patients,and summary the characteristics of the cases.General information(including name,sex,age and so on),basic diseases, symptoms, physical examination,laboratory examination,electrocardiogram examination, transthoracic echocardiography(TTE),ultrasonography of lower extremity veins,pulmonary arteriography,treatment,prognosis,adverse reaction and so on were filled in the table of patient’s person document.3. Following up the PTE patients who were treated in the Affiliated Hospital of Chengde Medical College from September 2012 to September 2014 1 month,3 months,6 months after accepted treatment and filled in the table.Results:1. Basic feature of PTE patientsA total of 209 PTE patients were treated in the Affiliated Hospital of Chengde Medical College from January 2009 to September 2014.There were 178 acute PTE patients were enrolled in this study.94 male and 93 female included.Their age were from 24 to 89,and the average age was(60.98±14.24) years old.The division that the patients in included pneumology department,osteology deparetent, general surgery department,gynecology department and so on.5 patients accepted prophylactic anticoagulation therapy in peroperative period.The main symptoms included dyspnea,cough,oppression in chest,pleuritic chest pain and so on.64.2% of the patients had deep venous thrombosis(DVT).179 cases became better and leave hospital after treatment,but 8 cases died.2. The clinic characteristics of PTE patients with PHThe pulmonary artery systolic pressure rised in 63.1% PTE patients. Patients were divided into two groups according to the PASP measured by transthoracic echocardiography-pulmonary hypertension(PH) group 118 cases and non-PH group 69 cases.The average age,the constituent ratio of female, the incidence rate of operation or trauma,the number of smoking in PH group were higher than in PH group,and the differences had statistical significance(p<0.05). In clinical symptoms, the incidence rate of syncope was higher in PH group than in non-PH group,but the incidence rate of pleuritic chest pain was lower in PH group.The difference between two groups had statistical significance(p<0.05).The platelets counts in PH group is less than that in non-PH group,but the incidence rate of the inversion of V1-3T wave was higher in PH group.The difference between two groups had statistical significance(p<0.05).Female and old age were risk factors for PTE with PH patients according to Logistic regression analysis.3. The clinic characteristics of elderly PTE patientsDividing the PTE patients into two groups according to the age-young or middle-aged group(<60 years)88 cases and elderly group(≥60 years)99 cases. The average age in young or middle-aged group was(48.1±7.8)years old,and in elderly group was(74.4±7.2)years old. The difference of sex between two groups had no statistical significance(p>0.05).The ratio that elderly PTE patients combined hypertension,coronary heart disease,thromboembolic or vascular diseases were higher than young or middle-aged patients( p<0.05).Compared with young or middle-aged group,the ratio of appearance of PH and DVT in elderly group were higher(p<0.05).12 patients in elderly group occured adverse drug reactions(such as bleeding,dysfunction of liver,thrombopenia and so on)after accepted treatment, and 16 patients in young or middle-aged group occured adverse reaction.The difference between two groups had no statistical significance(p>0.05).92 cases in elderly group became better,84 cases in young or middle-aged group became better.The difference between two groups had no statistical significance(p>0.05).4. The clinic characteristics of PTE patients in peroperative period31 cases of PTE patients had operation or trauma.27 of them got PTE after 2 to 10 days after had operation.13 patients had fracture operation.5 patients had operation on abdominal region.5 cases had pelvic surgery.2 patients got PTE after natural childbirth.1 patient had stripping of varicose saphenous vein and 1 patient had stent implantation of coronary artery.Among the 27 patients,5 patients had accepted prophylactic anticoagulation therapy.The main symptoms included dyspnea(27 cases), pleuritic chest pain(7 cases), hemoptysis(4 cases) and cardiopalmus(4 cases).The D-dimer of all the patients were higher than 500μg/L.28 patients among the 31 PTE patients had accepted treatment. 5 patients of them accepted thrombolysis therapy and 23 patients accepted pure anticoagulation therapy.All of the 28 PTE patients became better and leave hospital.3 patients died.5. The clinic characteristics of PTE patients with DVTDividing the PTE patients into two groups according ultrasonography of lower extremity veins-DVT group 120 cases and non-DVT group 67 cases. The difference of age and sex between two groups had no statistical significance(p>0.05). The incidence rate of operation or trauma,varicose vein of lower extremity in DVT group were higher than in non-DVT group, and the differences had statistical significance(p<0.05).The incidence rate of syncope, swelling and distension of lower extremity were higher in DVT group than in non-DVT group,and the difference between two groups had statistical significance(p<0.05).The platelets counts in DVT group was less than that in non-DVT group,and the difference between two groups had statistical significance(p<0.05).The difference that how many patients combined PH between two groups had no statistical significance(p>0.05).6. The right heart functional rehabilitation of PTE patients after different treatmentA total of 44 acute PTE patients who were treated in our hospital from September 2012 to September 2014 were enrolled in the study. According to different therapies,they were divided into two groups –thrombolysis therapy group 18 cases and pure anticoagulation therapy group 26 cases. Observing the changes of the configuration,function of right heart and PASP according to echocardiography in prior treatment,1 month,3 months and 6 months after treatment.Neither in prior treatment nor in post-treatment the difference of right heart functional parameters between thrombolysis therapy group and pure anticoagulation therapy group had statistical significance(p>0.05). Both of the two groups PTE patients’ right heart function had been improved after treatment, and the difference on right heart functional parameters between prior treatment and post-treatment had statistical significance(p<0.05). The PASP descended obviously after 1 month treatment.2 patients’ PASP still higher than 50 mmHg after 3 months regular anticoagulation therapy and became to chronic thromboembolic pulmonary hypertension(CTEPH).Conclusion:1. PTE could occurred in various divisions in hospital.The clinical manifesration was diverse.We should pay attention to this disease,diagnose in time and treat positively.2. Elderly,female PTE patients were more possible to had PH than others. The incidence rate of syncope and the inversion of V1-3T wave were higher in PH group than that in non-PH group. But the incidence rate of pleuritic chest pain and the platelets counts were lower in PH group.3. Elderly PTE patients always had several basic diseases,and it was more common to combine PH or DVT.Their prognosis was always fine after positive diagnosis and treatment.4. Acute PTE was one of serious complications caused to death.To the patients that would to be operated with risk factors of PTE,we should take prophylactic measures according to therapy guide and patients’ clinical condition in peroperative period and treat it positively.5. PTE patients who had operation or trauma,varicose vein of lower extremity were more possible to had DVT than others. The incidence rate of syncope,swelling and distension of lower extremity were higher in DVT group than that in non-DVT group. But the platelets counts was lower in DVT group.6. The right heart function of acute PTE patients could be improved after treated positively.Especially the PASP descended obviously after 1 month treatment.For most of the PTE patients,the right heart function could recover normal after accepting regular anticoagulation therapy.But it was possible to aggravated to CTEPH.