Risk Factors Analysis Of COPD Patients Undergoing CT-PTLB Complicated With Pneumothorax And Hemorrhage

Objective:In this study,clinical data of CT-guided percutaneous transthoracic lung biopsy in patients with chronic obstructive pulmonary disease were analyzed to find the risk factors for pneumothorax and bleeding,and to provide evidence for the safety of CT-PTLB in clinical COPD patients.Methods:In this retrospective case-control study,107 patients with COPD who underwent CT-PTLB in our hospital from October 2020 to October 2021 were collected.Through the image browser and electronic medical record system of our hospital,patients’medical records were consulted,and patients’demographic data,relevant examination data and puncture technology data were collected,including:Previous medical history,length of hospitalization,hospitalization cost,lesion size,estimated pulmonary arterial systolic pressure,coagulation index,pulmonary function index,puncture lobe,puncture number,puncture location,puncture depth,puncture Angle,puncture subject,lesion density,etc.The groups were grouped according to whether pneumothorax or pulmonary hemorrhage,and the differences among the groups were compared.The risk factors of pneumothorax and hemorrhage were analyzed by binary Logistic regression model.P<0.05 was considered statistically significant.Results:1.A total of 107 patients were included in this study,and the incidence of pneumothorax was 43.925%（47/107 cases）,among which the incidence of severe pneumothorax was 0.934%（1/107 cases）,and the catheter insertion rate was 0.934%（1/107 cases）.The incidence of pulmonary hemorrhage was 24.299%（26/107 cases）,and the incidence of massive pulmonary hemorrhage was 1.896%（2/107 cases）.No serious complications such as air embolism,pleural infection and needle implantation metastasis occurred.2.The results of univariate analysis show that:There were significant differences in puncture depth≥3cm（P=0.001）,puncture Angle≤50°（P=0.034）,uneven lesion density（P=0.000）,malignant lesion nature（P=0.007）FEV₁/FVC（P=0.000）in COPD patients receiving CT-PTLB pneumothorax group compared with non-pneumothorax group（P=0.000）<0.05).3.Binary Logistic regression analysis showed that:Heterogeneous lesion density（OR=82.755,95%CI:12.632-542.141,P=0.000）was an independent risk factor for pneumothorax after CT-PTLB in COPD patients,and FEV_1/FVC（OR=0.863,95%CI:0.790-0.943,P=0.001）was a protective factor for pneumothorax after CT-PTLB in COPD patients.4.Univariate analysis showed that compared with the non-pulmonary hemorrhage group,there were statistically significant differences in pulmonary artery systolic blood pressur≥35mm Hg（P=0.008）in COPD patients receiving CT-PTLB pulmonary hemorrhage group,pulmonary surgery history（P=0.021）,and paracentesis patients with minor height and above group（P=0.035）.5.Binary Logistic regression analysis showed that:Estimated pulmonary systolic blood pressure≥35mm Hg（OR=3.733,95%CI:1.406-9.907,P=0.008）,pulmonary surgery history（OR=2.878,95%CI:1.041-7.955,P=0.042）was an independent risk factor for pulmonary hemorrhage in COPD patients undergoing CT-PTLB.Conclusions:1.Uneven focus density is an independent risk factor for CT-PTLB complicated pneumothorax in COPD patients,and increased FEV1/FVC is a protective factor for CT-PTLB complicated pneumothorax in COPD patients.2.Estimated pulmonary systolic blood pressure≥35mm Hg and pulmonary surgical history are independent risk factors for CT-PTLB complicated with pulmonary hemorrhage in COPD patients.