| Community-acquired pneumonia is a common respiratory disease,and its incidence increase with aging.CAP is a common disease that causes hospitalization and death in elderly patients.With aging of population,CAP gets more and more attention.However,factors such as onset hidden,atypical clinical symptoms,complex pathogens and easy to be combined with multiple complication are the main reasons for the increase of failure treatment rate.Pulmonary embolism(PE)is a serious complication of elderly CAP patients and it is one of the main reasons for the increase of mortality in elderly CAP patients.When CAP is combined with PE,its clinical symptoms are similar to those of simple CAP that is easy to be missed diagnosed,especially for the primary hospital where CTPA is not popular or patients with poor tolerance.Therefore,it is particularly important to look for other methods that can reduce the missed diagnosis rate of CAP with PE.Objective:Comparing the differences of general information,underlying diseases,clinical symptoms and laboratory tests between CAP with PE and CAP in elderly patients and exploring the clinical characteristics and risk factors of elderly CAP with PE to look for early screening indicators of CAP with PE so as to reduce missed diagnosis and improve the prognosis of patients.Method:Collecting 670 patients hospitalized with CAP in the department of respiratory medicine from October 2016 to October 2018 and there were140 patients with higher D-dimer who underwent computed tomography pulmonary angiography(CTPA).All patients were divided into two groups according to the results of CTPA: CAP with PE group and CAP group.Comparing differences of gender,age,underlying diseases,clinical symptoms and labortary tests of the two groups.Results:1.The average age of patients in the CAP with PE group was higher than that in the CAP group,and the difference was statistically significant(P<0.05).There was no significant difference in gender between the two groups(P>0.05).2.The number of patients with hypertension,coronary atherosclesotic heart disease,chronic obstructive pulmonary disease,diabetes,tumor and long-term bedridden in CAP with PE group was significantly higher than that in CAP group and the difference was statistically significant(P<0.05).3.There was no significant difference in the symptoms of expectoration,cough,hemoptysis and fever between the two groups(P>0.05).Patients in the CAP with PE were more prone to syncope,chest pain and dyspnea,and the difference was statistically significant(P<0.05).4.There was no significant difference in blood WBC,C-reactive protein and procalcitonin between the two groups(P>0.05).The level of blood D-dimer and fibrinogen of patients in CAP with PE group was significantly higher than that in CAP group and the difference was statistically significant(P<0.05).5.By comparing blood gas between the two groups,patients in the CAP with PE group were more likely to have respiratory failure than those in the CAP group and the difference was statistically significant(P<0.05),there was no significant difference in PCO2 between the two groups(P>0.05).6.Patients in the CAP with PE group were more prone to right ventricular dysfunction and the difference was statistically significant(P<0.05).7.The diagnostic value of D-dimer for CAP with PE in the elderly was moderate,while the diagnostic value of fibrinogen was low.Conclusions:1.Pulmonary infection can activate inflammatory response and coagulation system,and the coagulant substances and blood viscosity increase in elderly CAP patients,which make it easy to be combined with PE.2.The D-dimer level increase in acute PE,and it also increase in some patients with CAP.The D-dimer level in elderly patients of CAP with PE is higher than that of simple CAP.3.For elderly CAP patients,the increasing D-dimer can be seen as early warning signal of CAP with PE.The study has more clinical value for basic-level hospitals that CTPA is not widely available and for severe patients not suitable for CTPA examination. |
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