Clinical Study Of Patients With COPD Complicated PE

COPD it is the fourth-leading cause of mortality.Most COPD-related deaths occur during periods of exacerbation.Dyspnea inpatients with known chronic obstructive pulmonary disease(COPD)can be a clinical challenge due to the nonspecific nature of atypical presentations. Diagnosis of PE is difficult in patients with COPD and exacerbation. Pulmonary embolism and deep venous thrombosis represent the spectrum of one disease.Annually,as many as 300,000 people in the United States die from acute pulmonary embolism,and the diagnosis is often not made until autopsy. PE is an important diagnosis to establish, given that undiagnosed PE has a hospital mortality rate as high as 30%, which falls to a near 8% if diagnosed and treated appropriately.Risk factors for PE identified in de present study:previous deep-vein thrombosis or PE,surgery within 2months,malignant disease,bed rest≥5 days, trauma,clinical congestive heart failure,COPD,age≥70 years.A compilation of studies examining the incidence of DVT in patients with COPD reported a rate of 10%-12%,though this number may far underestimate actual prevalence.The risk of DVT appears increased due to poor mobility with chronic steroid use,and active smiking.Tillie-Leblond et al compared symptoms on presentation in COPD patients with and without PE.They failed to find significant differences in the occurrence of dyspnea,chest pain,hemoptysis,cough,or palpitation between these two groups. Monreal et al found that electrocardiographic abnormalities such as atrial fibrillation or right bundle block appeared more often in patients with COPD complicated PE.Chest radiograph was more often abnormal in patients with COPD complicated PE,with both enlarged cardiac size and vascular redistribution signs appearing more often.Hypoxemia remained a shared blood gas finding nonspecific to either disease.In the COPD acute setting, hypercapnea may be increased secondary to worsened deadspace ventilation and ventilation/perfusion mismatch caused by increased mucus production, bronchial constriction,or worsened alveolar- capillary interface destruction with disease progression. Tillie-Leblond et al found that a drop in PaCO₂ of 5mmHg or more as statistically indicative of concomitant PE.Work by Hartmann and colleagues (2000)found similar distribution of D-dimmer results in 313 patients with and without COPD,suggesting COPD had no influence on the diagnostic accuracy of the test for thromboembolic disease .Sohn and colleagues(2006)found the combination of a low pretest probability and negative D-dimmer among subsets of patients with increased age ,prior malignancy,heart failure,or COPD sufficient in ruling out PE in 98% of all-comers.Hartmann and colleagues found that V/Q perfusion scanning in patients with COPD yielded a 79% specificity and 92% sensitivity ,compared with non-COPD patients, the difference was not significant. Similarly, CTPA sensitivity(53%) and specificity(91%)and among non-COPD patients with no significant difference (CTPA sensitivity 70%, specificity 85%).V/Q perfusion scanning and CTPA has the same diagnostic performance in patients with and without COPD.This is a review clinical comparison research, selects 12 example COPD to merge the PE case, and 15 example pure COPD case, analyzes COPD to merge the PE group case's risk factor, compared with two group of patients in the clinical symptoms, arterial blood gas analysis's characteristic, to instruct the clinical work.In this study, 12 patients with COPD combined PE cases, 7 cases (58.3%) simultaneously diagnoses for DVT,.5 patients (41.7%) recently received surgery. Two patients (16.7%) had malignancy, including one for the old (90 years) patients with lung adenocarcinoma, the other with breast cancer. Two patients (16.7%) had previous history of thromboembolism, including one case of recurrent pulmonary embolism as the other patients had a history of deep vein thrombosis. 1 patient had history of hypertension, 1 patient had history of diabetes. COPD patients and the general population suffering from similar risk factors for pulmonary embolism, including past history of thromboembolism, surgical history, history of other malignant tumors.Our study compared the pure COPD group and COPD + PE group of patients in clinical symptoms and signs. The incidence of cough, sputum, hemoptysis, dyspnea, chest pain in COPD patients were 100%, 6.7%, 80%, 13.3%, COPD + PE group in the incidence of clinical performance were 50%, 91.7 %, 25%, 16.7%. Both did not demonstrate significant differences. Two groups of patients with pulmonary rales (COPD group alone was 80%, COPD + PE group, 50%), pleural effusion (COPD group alone was 26.7%, COPD + PE group, 33.3%), right heart failure (pure COPD group was 6.7%, COPD + PE group, 25%) of the signs was no significant difference. COPD + PE group of patients with lower limb asymmetry of the incidence of edema in patients with COPD was significantly higher than the simple (simple COPD group 0, COPD + PE group, 58.3%), the difference was statistically significant (P <0.05).Our study compared the COPD group and COPD + PE group patients on admission PO₂, PaCO₂. The result of COPD patients admitted to PO₂was 56.53±9.05mmHg, COPD + PE group was 59.83±10.00mmHg, no significant difference between the two groups. PaCO₂ of pure COPD patients admission was 64.47±9.92 mmHg, COPD + PE group was 33.75±4.96mmHg, PaCO₂ between the two groups were significant differences. With pulmonary embolism, PaCO₂was significantly lower than COPD alone.In summary, when the clinical symptoms are not typical for patients with AECOPD, we should carefully assess their risk for pulmonary embolism. We should carefully evaluate the risk factors, carry on D-dimer, blood gas analysis, lower extremity Doppler ultrasound, CTPA, V/Q perfusion scanning etc, timely diagnosis and treatment.