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目的分析慢性阻塞性肺疾病急性加重期(AECOPD)患者合并急性肺动脉栓塞(APE)的相关危险因素。方法选取2014年8月至2015年8月收治的198例AECOPD患者为研究对象,在患者入院当日进行全面检查,包括血液生化指标与非血液指标,根据患者是否合并APE分为合并组50例与非合并组148例,比较两组临床表现及各项相关指标检查结果。结果两组在卧床时间≥7 d、双下肢不等粗≥1 cm、DVT以及Pa CO2下降≥5 mm Hg等4项指标比较差异有统计学意义(P均<0.01);合并组的D-二聚体(D-D)和血清内皮素-1(ET-1)水平显著高于非合并组(P均<0.01);Pearson相关性分析表明合并组的D-D水平与ET-1水平呈显著正相关性(r=0.483,P=0.000),而Pa O2与ET-1水平呈负相关性(r=-0.668,P=0.029)。结论卧床时间≥7 d、双下肢不等粗≥1 cm、DVT、Pa CO2下降≥5 mm Hg以及D-D与ET-1水平升高均为AECOPD合并APE的高危因素,加强这些因素的排查及对症处理是改善AECOPD患者临床治疗预后的重要保障。
Objective To analyze the risk factors associated with acute pulmonary embolism (APE) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A total of 198 patients with AECOPD admitted from August 2014 to August 2015 were enrolled in the study. Patients were enrolled on the day of admission to conduct a comprehensive examination, including biochemical and non-hematological indicators. According to whether the patients were combined with APE, 50 patients with AECOPD were enrolled in the study. 148 cases of non-combined group, comparing the two groups of clinical manifestations and related indicators test results. Results There were significant differences between the two groups in the time of bed rest ≥7 days, the double lower extremities unequal thickness ≥1 cm, the DVT and the decrease of PaCO2 ≥5 mm Hg in both groups (P <0.01) (DD) and endothelin-1 (ET-1) were significantly higher than those in non-combined group (all P <0.01). Pearson correlation analysis showed that there was a significant positive correlation between DD level and ET-1 level (R = 0.483, P = 0.000), while Pa O2 was negatively correlated with ET-1 level (r = -0.668, P = 0.029). Conclusions The bed rest time ≥7 days, double lower extremities unequal thickness ≥1 cm, DVT, Pa CO2 decrease ≥5 mm Hg, DD and ET-1 level are the risk factors of AECOPD complicated with APE, and the investigation and symptomatic improvement of these factors Treatment is an important guarantee for improving the prognosis of AECOPD patients.