Pulmonary Thromboembolism: A Comparison Of Clinical Features Between Younger And Older Patients

BackgroundPulmonary thromboembolism (PTE) is a disease or syndrome that pulmonary arteries or its branches are obstructed by thrombosis from the venous system or right heart. Pulmonary embolism is PTE commonly. Research indicates that age is one of the most independent risk factors for PTE. However, with people lifestyle and diet changes in recent years, it is found that younger PTE increased gradually, which has been a major death cause of the younger. The differences and similarities of clinical features between the younger and older PTE are still no fully cognition, therefore, to compare clinical features between younger and older PTE patients, and improve the acknowledge of clinicians to PTE, which has an actrual values.ObjectiveTo compare the clinical presentation of younger and older patients with acute pulmonary embolism, and provide pertinent measures of diagnosis, treatment and prevention for different aged PTE patients.MethodsThis is a descriptive study for PTE.178 patients in our hospital diagnosed as PTE from 2007 Jan to 2009 Dec, are divided into two group:the younger group (18 years old≤age<60 years old,97 cases) and older group (≥60 years old,81 cases) according to the world health organization (WHO). Keep detailed records of gender, age, history of secondary risk factors (including DVT, pulmonary disease, phlebitis or varicose veins, cancer, hypertension, coronary heart disease, diabetes, cerebral hemorrhage, cerebral infarction, rheumatic autoimmune diseases, fractures/surgery, recent braking), clinical symptoms (including dyspnea, chest pain, syncope, cough, hemoptysis, palpitations, sense of fear and dying, triad, etc.), and signs (including fever, tachybreath, tachycardia, cyanosis, jugular vein distended, tricuspid murmur, P2 hyperthyroidism, pulmonary rales, lower extremity swelling and pain), PTE clinical classification, the outcome after standard therapy and distribution of DVT thrombosis, then compare similarities and differences between two groups.Results1. baseline data 178 patients in our hospital diagnosed as PTE from November 2006 to November 2009, male 96 and female 82, male to female ratio 1.17:1, the younger group (<60 years old) 97 cases, accounting for 54.5%, male 57, female 40, aged from 19 to 59 years old, average age (44.75±9.39); the elder group (≥60 years old) 81 cases, accounting for 45.5%, male 39 and female 42, aged from 60 to 85, the average age (68.40±5.86). The ratio of male to female has no significant differences between the two groups (P>0.05) there is also no significant differences between male and female patients in different aged periods (P>0.05)2. Risk factors The incidence rate of pulmonary disease, coronary heart disease, cerebral infarction in the younger group were significantly lower than those in the older group (χ2=4.75-5.56, P<0.05), but the incidence of rheumatic autoimmune diseases significantly higher in the younger group than that in the older group (P<0.05), other risk factors have no significantly differences between the two groups.3. Clinical symptoms and signs The most common symptoms in PTE patients is dyspnea (159 cases,89.3%) and cough (94 cases,52.8%) and the common sign is shortness of breath (90 cases,50.6%), followed by P2 louder (65 cases,36.2%)) and cyanosis (59 cases,33.1%). The incidence rates of chest pain, hemoptysis, syncope in the older group is higher than that in the younger group (χ2=4.69-7.02, P<0.05); and the elder patients have more positive signs and higher appearance of pulmonary rales than the younger group (χ2=5.89,P<0.05)4. The severity and prognosis There are no significant differences in recovery rate and mortality between the two groups (χ2=0.07-1.42, P>0.05), the older group has more massive or sub-massive PTE patients than the younger group (χ2=4.29,P<0.05)5. DVT There are 152 patients with DVT in 178 PTE cases, accounting for 85.4%, that includes younger patients 74 cases (76.3%), older patients 66 cases (81.5%) and there is no significant differences between the two group (χ2=0.71, P>0.05). The left iliac vein and superficial femoral vein have higher than the right. (χ2=4.94-5.29, P＜0.05).The younger group has a higher inciedence of Iliac vein DVT than the older group (χ2=8.48, P<0.05)Conclusion1. In addition to fractures/surgery, phlebitis/varicose veins and other common risk factors, younger PTE patients have some ones like autoimmune diseases, economy syndrome, oral contraceptives, while older patients like lung disease, cardiovascular and cerebrovascular diseases.2. Older patients have a higher incidence of massive or sub-massive PTE than the younger.3. The incidence of DVT is higher in left lower extremity than in the right, and easily happened in iliac, superficial femoral vein.