| Objective:To study the clinical characteristics and risk stratification of elderly patients with pulmonary thromboembolism,and to improve the understanding of pulmonary thromboembolism in elderly patients.Methods:This study retrospectively analyzed 330 patients with pulmonary thromboemb-olism in the cardiovascular department of our hospital from September 2017 to August 2019.54 patients without CT pulmonary angiography,non-thromboembolism and incomplete clinical data were excluded.The remaining 276 patients with PTE were included in the study.According to age,133 cases were divided into elderly group(?65 years old)and 143 cases into non-elderly group(<65 years old).According to sex,elderly patients with PTE were divided into elderly male group(66 cases)and elderly female group(67 cases).According to the risk stratification method in the guidelines for diagnosis,treatment and prevention of pulmonary thromboembolism published by Chinese Medical Association in 2018,elderly patients with PTE were divided into low risk group(27 cases)and medium/ high risk group(106 cases).General data(sex,age,systolic and diastolic blood pressure on admission),clinical symptoms(dyspnea,chest pain,syncope,hemoptysis,palpitation,abdominal pain,lower limb swelling pain),past history(smoking,drinking,hypertension,diabetes,malignant tumor,heart failure,cerebrovascular disease,recent surgical or traumatic history),laboratory tests(cardiac troponin I,BNP,D-dimer,Blood gas analysis,blood routine,creatinine,blood lipid,neutrophils to lymphocytes ratio,platelets to lymphocytes ratio,lymphocytes to monocytes ratio),imaging examination(electrocardiogram,cardiac color ultrasound,CT pulmonary angiography,lower extremity vein color ultrasound),treatment and prognosis were recorded in each group.The data of each group were statistically analyzed,and the influencing factors of risk stratification in elderly patients with PTE were analyzed.All the above were analyzed by SPSS23.0 software.Results:1.The proportion of hypertension and cerebrovascular disease in the elderly group was higher than that in the non-elderly group(P<0.05),while the proportion of hemoptysis,smoking and drinking history in the elderly group was lower than that in the non-elderly group(P<0.05).There was no significant difference in sex,systolic blood pressure,diastolic blood pressure,dyspnea,chest pain,syncope,palpitation,abdominal pain,lower limb swelling,diabetes,malignant tumor,heart failure,recent operation or trauma history between the two groups(P>0.05).The levels of BNP and Cr in the elderly group were higher than those in the non-elderly group(P< 0.05),while the level of LMR in the elderly group was lower than that in the non-elderly group(P<0.05).There was no significant difference in cTNI,D-D,PO2,PCO2,WBC,Hb,RDW,PLT,MPV,TC,HDL-C,LDL-C,TG,NLR and PLR between the two groups(P>0.05).The proportion of AF,RBBB and lower limb DVT in the elderly group was higher than that in the non-elderly group(P<0.05),the level of LVEF in the elderly group was lower than that in the non-elderly group(P<0.05).There was no significant difference in T wave inversion in V1-V4 lead,sinus tachycardia,LVDd,RVDd,tricuspid regurgitation velocity,PAP and the proportion of pulmonary artery embolism between the two groups(P>0.05).In the sPESI score,the proportion of medium risk patients in the elderly group was higher than that in the non-elderly group(P<0.05).In the comprehensive assessment of risk stratification,the proportion of medium high risk patients in the elderly group was higher than that in the non-elderly group(P<0.05),while the proportion of low risk patients was lower than that in the non-elderly group(P<0.05),but there was no significant difference between medium low risk and high risk patients(P>0.05).There was no significant difference in the proportion of anticoagulation,thrombolysis,adverse events and hospital death between the two groups(P>0.05).2.The proportion of smoking and drinking history in the elderly male group was significantly higher than that in the elderly female group(P<0.05).There was no significant difference in age,systolic blood pressure,diastolic blood pressure,dyspnea,chest pain,syncope,hemoptysis,palpitation,abdominal pain,lower limb swelling,hypertension,diabetes,malignant tumor,heart failure,cerebrovascular disease,recent operation or trauma history between the two groups(P>0.05).The levels of Hb and Cr in the elderly male group were higher than those in the elderly female group(P<0.05).The levels of PLT,TG and LMR in the elderly male group were lower than those in the elderly female group(P<0.05).There was no significant difference in cTNI,BNP,D-D,PO2,PCO2,WBC,RDW,MPV,TC,HDL-C,LDL-C,PLR and NLR between the two groups.The level of LVDd and the proportion of RBBB in the elderly male group were higher than those in the elderly female group,and the proportion of T wave inversion in V1-V4 lead was lower than that in the elderly female group(P<0.05).There was no significant difference in AF,sinus tachycardia,LVEF,RVDd,tricuspid regurgitation velocity,PAP,pulmonary artery embolism and lower limb DVT between the two groups.In the sPESI score,the proportion of medium risk patients in the elderly male group was higher than that in the elderly female group(P<0.05).There was no significant difference in risk stratification comprehensive assessment,anticoagulation,thrombolysis,adverse events and hospital mortality between the two groups(P>0.05).3.The proportion of heart failure in the medium / high risk group was higher than that in the low risk group(P<0.05),and the proportion of cerebrovascular disease was lower than that in the low risk group(P<0.05).There was no significant difference in age,sex,systolic blood pressure,diastolic blood pressure,dyspnea,chest pain,syncope,hemoptysis,palpitation,abdominal pain,lower limb swelling,smoking,drinking,hypertension,diabetes,recent operation or trauma and malignant tumor between the two groups(P>0.05).The levels of cTNI and BNP in the medium / high risk group were higher than those in the low risk group,while the level of PCO2 was lower than that in the low risk group(P<0.05).There was no significant difference in D-D,WBC,Hb,RDW,PLT,MPV,Cr,PO2,TC,HDL-C,LDL-C,TG,NLR,PLR and LMR between the two groups(P>0.05).The levels of RVDd,tricuspid regurgitation velocity,PAP and the proportion of T wave inversion in V1-V4 lead,AF and pulmonary trunk embolism in the medium / high risk group were higher than those in the low risk group(P<0.05).There was no significant difference in RBBB,sinus tachycardia,LVDd,LVEF and lower limb DVT between the two groups(P>0.05).The proportion of thrombolysis and adverse events in the medium / high risk group was higher than that in the low risk group(P<0.05),but there was no significant difference in the proportion of anticoagulation and hospital death between the two groups(P>0.05).4.Include single-factor meaningful indicators cTNI,BNP,PCO2,T wave inversion in V1-V4 lead,AF,main pulmonary artery embolization,cerebrovascular disease,heart failure into the binary logistic regression,using progressive forward screening,the results suggest that T wave inversion in V1-V4 lead(OR = 5.684,P<0.05),main pulmonary artery embolism(OR = 7.477,P<0.05)are independent factors affecting risk stratification in elderly PTE patients.Conclusion:1.The clinical symptoms of elderly patients with PTE are not obvious,and they often have multiple underlying diseases,with higher risk stratification and prone to adverse events.Clinical diagnosis should be combined with previous medical history and related examinations to avoid misdiagnosis and missed diagnosis,treat as early as possible,and reduce adverse events.2.There was no significant difference in clinical symptoms between elderly male and female patients with PTE.However,there are more risk factors,higher proportion of RBBB and higher sPESI score in elderly male patients with PTE,while the proportion of T wave inversion in V1-V4 lead in elderly female patients with PTE is higher,which is prone to adverse events.3.T wave inversion in V1-V4 lead and main pulmonary artery embolism are independent influencing factors of risk stratification in elderly patients with PTE.Clinicians can further evaluate the risk stratification of PTE in the elderly with ECG and CTPA results. |
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