Study On The Correlation Between Deep Venous Thrombosis In Different Parts Of Lower Extremity And The Severity Of Pulmonary Hypertension After Acute Pulmonary Embolism

Objective:To analyze the correlation between deep venous thrombosis of lower extremity and the severity of pulmonary hypertension after acute pulmonary thromboembolism,and to explore the pathological process of APTE hemodynamic changes caused by deep venous thrombosis of lower extremity.Methods:Collect general data and the inspection indicators of lower extremity vascular doppler ultrasound,echocardiography and brain natriuretic peptide from October2013 to August 2020 from patients who were first diagnosed as APTE affiliated Hospital of Chengde Medical College with method of retrospective study.According to the inclusion criteria and exclusion criteria,231 patients were screened out.Blood vessel Doppler ultrasound of lower extremity was used to determine the DVT of lower extremity and according to the pathological anatomy of venous thrombosis of lower extremity,it was divided into 4 groups: intermuscular venous thrombosis group,tibiofibular vein thrombosis group,femoral popliteal vein thrombosis group,inferior iliac vein thrombus group.Pulmonary artery systolic blood pressure,pulmonary artery trunk width,right ventricular outflow tract width and right ventricular diameter width were obtained by echocardiography results.And make classification of severity according to pulmonary artery pressure.SPSS 22.0software was used for statistical analysis: the measurement data are represented by mean ± standard deviation and the data was performed by single factor ANOVA analysis when it was consistent with the homogeneity of variance.Comparison between the groups was performed by t or calibration test.Counting data was expressed as a percentage,and was performed by chi-square test.Non-parametric rank sum test was used to measure non-normal distribution and grade data.P<0.05 was statistically significant.Results:1.There were 231 patients collected in the groups,including 94 cases of intermuscular vein thrombosis in the calf,31 cases of tibiofibular vein thrombosis,90 cases of femoral popliteal vein thrombosis and 16 cases of inferior iliac vein thrombosis.There was no significant difference in age,sex,systolic blood pressure,diastolic blood pressure,heart rate of four groups of patiens(P>0.05).2.There was a correlation between deep venous thrombosis of lower extremity and the level of PASP before treatment,and the difference was statistically significant(P<0.05).The level of pre-treatment PASP was significantly higher in the group of intermuscular vein thrombosis in the lower leg compared with that in the group of femoral popliteal vein and inferior iliac vein thrombosis(P<0.05);the level of pre-treatment PASP was higher in the two groups of tibiofibular vein thrombosis and femoral popliteal vein compared with that in the group of inferior iliac vein thrombosis(P<0.05);Although there is a downward trend of the level of pre-treatment PASP between the group of intermuscular vein thrombosis and the group of tibiofibular vein thrombosis,the difference was not significant(P>0.05);Although there is a downward trend of the level of pre-treatment PASP between the group of tibiofibular vein thrombosis and the group of intermuscular vein thrombosis and the group of inferior iliac vein thrombosis,the difference was not significant(P>0.05).3.There was a correlation between deep venous thrombosis of lower extremity and the level of BNP,and the difference was statistically significant(P<0.05).The level of BNP was significantly higher in the group of intermuscular vein thrombosis in the lower leg compared with that in the group of femoral popliteal vein and inferior iliac vein thrombosis(P<0.05);The group of tibiofibular vein thrombosis and the group of femoral popliteal vein thrombosis compared with the group of inferior vena cava thrombosis,although the BNP level of patients decreased,but there was no significant difference(all P>0.05);There was no statistically significant difference between the group of intermuscular vein thrombosis in the lower leg and the group of tibiofibular vein thrombosis(P>0.05);Although there is a downward trend of the level of BNP between the group of tibiofibular vein thrombosis and the group of intermuscular vein thrombosis and the group of inferior iliac vein thrombosis,the difference was not significant(P>0.05).4.There was a correlation between deep venous thrombosis of lower extremity and pulmonary artery trunk width,right ventricular outflow tract width and right ventricular diameter width,and the difference were statistically significant(P<0.05).Among them,pulmonary artery trunk width,right ventricular outflow tract width and right ventricular diameter width was higher in the group of intermuscular vein thrombosis in the lower leg compared with that in the group of femoral popliteal vein and inferior iliac vein thrombosis(P<0.05);Pulmonary artery trunk width,right ventricular outflow tract width and right ventricular diameter width were higher in the two groups of tibiofibular vein thrombosis and femoral popliteal vein compared with that in the group of inferior iliac vein thrombosis(P<0.05);Although there were downward trends of pulmonary artery trunk width,right ventricular outflow tract width and right ventricular diameter width between the group of intermuscular vein thrombosis and the group of tibiofibular vein thrombosis,the difference was not significant(P>0.05);Although there were downward trends of pulmonary artery systolic blood pressure,pulmonary artery trunk width,right ventricular outflow tract width and right ventricular diameter width between the group of tibiofibular vein thrombosis and the group of intermuscular vein thrombosis and the group of inferior iliac vein thrombosis,the difference was not significant(P>0.05).Conclusion:The severity of pulmonary hypertension after acute pulmonary thromboembolism is associated with deep venous thrombosis in different parts of the lower extremity.The higher severity of PH after APTE,the easier it maybe to detect thrombosis in a small deep vein at the distal extremity.Early attention should also be paid to patients with distal deep venous thrombosis of lower extremity.