Clinical Manifestations Of Chronic Obstructive Pulmonary Disease Complicated With Pulmonary Thromboembolism

Objective:Pulmonary thromboembolis(PTE) refers to venous systerm or pulmonary heart's thrombus that travels to the lungs through the pulmonay circulation, causing pulmonary circulation and respiratory dysfunction. The most common symptom of acute PTE is dyspnea, which is often sudden in onset, pleuritic chest pain and hemoptysis occur more commonly with pulmonary infarction. Chronic obstrctive pulmonary disease(COPD) is common in respiratory systerm disease. Because pulmonary fuction decrease progressively, the body suffer hypoxia condition in long term, secondary polycythemia,blood viscosity increase, so the patients with COPD develop PTE easily. Diagnosis of concomitant PTE in these patient is often missed because symptoms of acute exacerbation of COPD may mimic PTE, affect people's quality of life and prognosis. This paper explore the characteristics of the clinical manifestation and the imaging, diagnosis, treatment and prognosis of COPD complicated with PTE, which would increase the physicians'understanding of it.Clinical Date Research Methods:Retrospective analysis of the First Affiliated Hospital of Dalian Medical University, 6-year period(2005-2010)20 cases of COPD + PTE in patients with clinical date, and to collect the same period 20 cases of pure COPD patients with such information, the collection of acute symptomatic pulmonary thromboembolism in patients with sex, age and other clinical date in general; the clinical manifestation such as cough, sputum, dyspnea, chest pain,pulmonary rales,lower limb asymmetry of edema and so on; deep venous thrombosis(DVT), cancer, history of recent surgery, immobilization and other risk factors; as well as blood gas analysis, hemoglobin, D-dimer, electrocardiogram (ECG), and computed tomography pulmonary angiography(CTPA). Analysis the risk factors of COPD+PTE group, compare the difference of the two groups'clinical symptoms and signs, blood gas analysis, hemoglobin, D-dimer, ECG. SPSS17.0 software was used, Measurement date using T tests method, group comparison using X2 Test. P<0.05 is statistically significant.Result:COPD+PTE group and pure COPD group age, gender are not significant. (P values were 0.529 and 0.751 ). The major risk factors in case group are age≥75 years old(50%), DVT(45%), immobilization(25%), cancer(15%), and history of recent surgery(10%). We fail to find significant differences in the occurrence of dypnea, chest pain, hemoptysis, cough and sputum between these two groups(P>0.05). COPD+PTE group take place syncope higher than pure COPD group,significant difference between the two group(P<0.05), other indicators such as pulmonary sales,fever and P2>A2 are no significant difference. The incidence of hypotension and both lower extremities asymmetry edema in COPD+PTE group are higher than pure COPD group,significant difference between the two group. Our study compare these two group patients on admission PH,PaO2,PaCO2 and P(A-a)O2.The result of pure COPD group patients admitted to PaO2 75.20±24.87 mmHg, COPD+PTE group was 69.61±17.22 mmHg, no significant difference between the two groups. PaCO2 of pure COPD group patients admission is 47.50±12.03 mmHg, COPD+PTE group is 37.02±6.11 mmHg. PaCO2 between the two groups are significant differences. P(A-a)O2 of pure COPD group patients admission is 24.48±14.17 mmHg, COPD+PTE group is 55.87±50.93 mmHg, P(A-a)O2 between the two groups are significant differences. Comparing the two groups patients, we find significant difference in D-dimer, but only 6 case (30%) D-dimer>0.5mg/L. Comparing the two groups patients, we find significant difference in hemoglobin (P=0). But the two group ECG are not significant difference(P>0.05). COPD+PTE group patients are undertook dangerous hierarchy after diagnosis, 4 cases(20%) in high risk group, give the active thrombolytic and anticoagulant therapy after primary treatment; The other 16 cases(80%) are in moderate risk group, give anticoagulant therapy,18 case(90%) improved, 2 case (10%) died.Conclusion: 1. When clinically patients with COPD appear syncope, low blood pressure, and have the PTE high-risk factors, especially with double lower limbs asymmetric edema, we need to alert the diagnose of PTE; 2. when patients with COPD complicated PTE, the blood gas PaCO2 is lower than before, but P (A - a) O2 obviously higher than before;3. We suggest that patient with COPD who have high risk factors of PTE should accept preventive anticoagulation therapy.