| Background:Chronic obstructive pulmonary disease(COPD)is a destructive disease of the respiratory system,the disease has a high incidence of high mortality characteristics of patients mostly in the elderly.Incomplete airflow reversibility is common to COPD patients with symptoms that usually manifests respiratory disease(sputum,cough,dyspnea,etcl.),COPD is a respiratory disease,but still no complete and effective measures to prevent the decline of lung function in patients with measures,once diagnosed,need life-long treatment.There are many causes of COPD,the current mechanism is not entirely clear for them,as most of the primary hospital patients from rural areas,the lack of adequate understanding of COPD and awareness,prevention and treatment of consciousness is not high,leading to primary hospital slow-block lung treatment control rate Low.Another grass-roots doctors on asthma and chronic obstructive pulmonary disease and other diseases recognized lack of primary treatment equipment is not universal,a new type of effective treatment of drugs did not reach the primary hospital in primary hospitals is also the main reason for the treatment of chronic obstructive pulmonary disease.Objective:Wells and modified Geneva score were used to evaluate 195 patients who could not explain the cause of the disease,and to evaluate their clinical value in assessing the severity of acute pulmonary embolism(PE).The clinical manifestation,laboratory examination and imaging of the acute exacerbation of chronic obstructive pulmonary disease(COPD)and acute exacerbation of chronic obstructive pulmonary disease complicated with pulmonary embolism were analyzed and compared,make the primary hospital doctors understand pulmonary embolism more better and attach importance to pulmonary embolism,provide a good basis for the diagnosis and treatment of the future.Methods:There were 900 AECOPD who were hospitalised in our department of respiration between January 2014 and June 2017,including 195 cases of patients with acute exacerbation of the disease can not explain the reason,the CTPA diagnosis of 195 cases of patients were divided into two groups,AECOPD group was 136 cases and the AECOPD combined with PE group was 59 cases,the two groups of patients with clinical manifestations,physical examination and a variety of diagnostic methods(including the laboratory examination and imaging features)were collected and analyzed.At the same time,the risk of pulmonary embolism was graded by the modified Geneva score and Wells score divided into three groups:low,moderate and high group,ROC curve was used to evaluate the diagnostic value of the two scoring methods by 195 patients who were able pulmonary embolism(PE),The result of CTPA was used as the diagnostic gold standard of pulmonary embolism,to analyze the pulmonary embolism diagnosis rate of patients in each group.Results:(1)One hundred and sixteen patients had a low clinical probability of PE modified Geneva score<3 points of which 25%(29/116)had proven PE,4-10 points was 62.93%(73/116)and 100%(14/14)in high probability score 11 points.The likelihood of pulmonary embolism increased with increasing scores,(P<0.001).The confirmed PE was20.5% in the 117 patients with a low probability Wells score(0-2 points),And the Wells score of pulmonary embolism possibility of 2-6 points was65.8%,>6 points was 100%.The probability of pulmonary embolism was related to the level of Wells score,(P <0.001).The receivers operating characteristic curve(ROC)area under the curve(AUC)of modified Geneva score diagnosis pulmonary embolism was 0.8597±0.07018(P=0.001206<0.01),sensitivity of ≥6.5 to predict pulmonary embolism was92.3%,specificity was62.3%;the area under curve AUC of the ROC curve in the Wells was 0.7269±0.09911(P=0.02009<0.05),the sensitivity of ≥2 to predict pulmonary embolism was 61.6% and the specificity was 98.4%.The AUC of the two groups has significant difference;The average age of AECOPD group and AECOPD group was 69.12 ± 9.86 years old and 67.20± 10.73 years old,most patients had different degrees of cough,sputum,dyspnea,chest tightness and palpitations,some patients also have a headache,abdominal pain,diarrhea,and other symptoms of hemoptysis,the clinical manifestations of the two groups no significant difference.Physical examination revealed both groups of patients with asymmetric edema of both lower extremities,but the AECOPD complicated with PE group of 8 cases(13.56%),the AECOPD group of 2 cases(1.47%),there was significant difference;(4)Laboratory examination of blood gas analysis showed that PaCO2 and PaO2 was not statistically significant in both groups,but the AECOPD group had 16 cases(27.12%)was lower than baseline of PaCO2,the AECOPD complicated with PE group was12 cases(9.56%),there was significant difference.The content of D-dimer was(263±59)μg/L and(612±192)μg/L in AECOPD group and complicated with PE group,respectively.The difference was statistically significant;(5)X-ray examination was not statistically significant;(6)ECG: Daniel ECG score criteria showed: AECOPD group and AECOPD with PE group had no significant difference in normal patients,and sinus tachycardia,thoracic lead ST-T,complete right bundle branch block and other symptoms,but the SIQIIITIII characteristics were 25 cases(18.38%)and 32 cases(54.24%),respectively,with significant difference.(8)59 cases of AECOPD with PE group underwent cardiac ultrasound examination,direct signs were found in 20 cases with right cardiac emboli,,indirect signs that 56 cases of acute pulmonary heart disease were ultrasound performance,doppler spectrum showed 4 cases with severe three tricuspid regurgitation,pulmonary arterial pressure increased,the moderate pulmonary hypertension in 53 cases,6cases showed mild pulmonary hypertension.(9)The 136 patients of AECOPD group,20cases(14.71%)were found to have thrombosis,and the 59 cases of patients AECOPD withPE group in the lower limb venous ultrasound examination found that up to 45 cases of thrombosis(76%),There were significant differences between the two groups.At the same time,we also found the thrombus mostly distributed in the iliac vein and femoral vein.Conclusion:The main clinical manifestations of acute exacerbation of chronic obstructive pulmonary disease and acute exacerbation of chronic obstructive pulmonary disease and pulmonary embolism of are cough,sputum,difficulty breathing,chest tightness,palpitations,headache fever and so on,the risk factors of patients with PE were hypertension,surgical history,history of thrombosis and so on,Wells and modified Geneva score for the diagnosis of PE has a good clinical reference value,blood gas analysis,D dimer,echocardiography and lower limb venous ultrasound examination can be used as a convenient and quick screening indicators,CTPA is an important and reliable clinical value for the diagnosis of PTE.Most of the patients in the primary hospital were ordinary farmers,low income,low cultural level,lack of awareness of pulmonary embolism,poor awareness of prevention,diagnosis and treatment is not timely,with low awareness,In the clinical work,the primary hospital and the basic level doctors for patients with atypical AECOPD should be careful to its risk assessment of pulmonary embolism,to improve the understanding of pulmonary embolism,So that Pulmonary embolism in the early stage can be timely and appropriate examination will help patients timely diagnosis and reduce mortality. |
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