Study On The Related Factors And Prognosis Of Acute Pulmonary Thromboembolism In Different Parts

Objective:To explore the clinical related factors of central pulmonary embolism,lobar and interlobar artery pulmonary embolism and peripheral pulmonary embolism in three groups of pulmonary embolism in different locations.To clarify the correlation between clinical indicators and the location of pulmonary embolism,summarize the clinical characteristics and prognosis of pulmonary embolism in different locations,and provide help for the accurate diagnosis,management and treatment of those embolism.Methods:From June 2012 to June 2019,patients with acute pulmonary thromboembolism diagnosed and treated in the Affiliated Hospital of Qingdao University were analyzed retrospectively.According to the inclusion and exclusion criteria,patients with complete clinical data were selected as the study objects.According to the location of pulmonary embolism in CTPA,the patients were divided into central pulmonary embolism group,lobar and interlobar artery embolism group and peripheral pulmonary embolism group.The general data,clinical symptoms,high risk factors,scores,blood test indexes,ultrasound information of heart and lower extremity blood vessels,risk stratification,prognosis（recurrence,thrombolysis,30 day mortality）were collected for statistical analysis.Factors with statistical differences were included in multi-factor Logistic regression analysis and draw ROC curves to evaluate the predictive value of each parameter for the location of pulmonary embolismResult:This study included 995 patients with acute pulmonary embolism,central pulmonary embolism group（394 cases）,lobar and interlobar artery embolism group（352cases）,peripheral pulmonary embolism（249 cases）.There was no significant difference in age,gender,BMI and smoking history among the three groups（P>0.05）.Compared with the other two groups,patients with central pulmonary embolism were more likely to have shortness of breath,dyspnea,syncope,tumor and DVT,especially proximal DVT（P<0.05）;And D-Dimer,hs-cTnI,NT-ProBNP,right ventricular anteroposterior diameter,P（A-a）O₂ level were higher,PaO₂ was lower and sPESI score was higher（P<0.05）.Compared with the peripheral pulmonary embolism,the central pulmonary embolism had more high-risk and middle-risk patients.The 30-day all-cause mortality and pulmonary embolism related mortality were higher.The complete thrombolysis rate was also higher after 3-month anticoagulation treatment（P<0.05）.There was no statistical difference in the recurrence of thrombus（P>0.05）;Compared with central pulmonary embolism,D-Dimer（OR=0.994,P<0.05）,P（A-a）O₂（OR=0.737,P<0.05）,shortness of breath and dyspnea（OR=0.202,P<0.05）,syncope（OR=0.257,P<0.05）,sPESI≥1（OR=0.293,P<0.05）were the independent protective factor for pulmonary embolism.While operation or trauma（OR=3.721,P<0.05）were the independent risk factors for pulmonary embolism.Compared with central pulmonary embolism,D-Dimer（OR=0.990,P<0.05）,NT-proBNP（OR=0.995,P<0.05）,P（A-a）O₂（OR=0.770,P<0.05）,right ventricular anteroposterior diameter（OR=0.005,P<0.05）,shortness of breath and dyspnea（OR=0.362,P<0.05）,syncope（OR=0.318,P<0.05）,combined tumor（or=0.178,P<0.05）,combined DVT（OR=0.366,P<0.05）,sPESI≥1（OR=0.185,P<0.05）,medium risk of risk stratification（OR=0.050,P<0.05）were the protective factors of peripheral pulmonary embolism,while chest pain（OR=4.300,P<0.05）,operation or trauma（OR=9.316,P<0.05）,oxygen partial pressure PaO2（OR=1.033,P<0.05）were the independent risk factors.Conclusion:Patients with central pulmonary embolism tend to have more serious clinical manifestations,higher risk,worse blood gas analysis,more prone to DVT and cardiac dysfunction,whose the 30 day all-cause mortality and pulmonary embolism related mortality were significantly higher than that of peripheral pulmonary embolism.However,not all the prognosis of patients with peripheral pulmonary embolism was good.For patients with bilateral extensive peripheral pulmonary embolism,early close monitoring,active respiratory and circulatory support treatment,and active follow-up of patients with thrombolysis should be carried out.Early determination of the type of pulmonary embolism had a certain value for the judgment of clinical prognosis and the choice of treatment.