The Analysis Of Risk Factors And Clinical Characteristics Of Chronic Obstructive Pulmonary Disease Complicated With Pulmonary Embolism

Objective To investigate the risk factors and clinical characteristics of Chronicobstructive pulmonary disease (COPD) complicated with Pulmonary embolism (PE)，improve the diagnosis consciouseness of those patients, diagnose and treat timely sothat to reduce the mortality. Methods This is a retrospective clinical comparisonresearch. We selected24COPD complicated with PE patients who were hospitalized inrespiration medicine or emergency department of The First Affiliated Hospital of AnhuiMedical University between January of2008and September of2012defined as casegroup (COPD combined PE group), the24patients were diagnosed with PE throughspiral CT/MRI and absence of symptom of respiratory tract infection(cough withsputum, fever, chills, infiltrates on CXR etc), while selected54acute exacerbation ofCOPD (Acute exacerbation of Chronic obstructive pulmonary disease，AECOPD）patients in the same period defined as control group (pure COPD group)，compared thedifferences of risk factors (including age, smoking history, surgery within6weeks,previous medical history etc), clinical symptom, physical sign, arterial blood gas,D-dimer, electrocardiogram and lower extremity Doppler ulstrasonography between thetwo groups. Differences between the two groups were analyzed using the SPSS13.0software. Results1.Risk factors: The incidence of previous venous thromboembolism,malignancy, surgery within6weeks, immobilization time≥7days in COPD+PE groupwere higher than pure COPD group and the differences were statistically significant（P0.05）.But the incidence of age≥65years, smoking, hypertension, diabetes, cardiac dysfunction in COPD+PE group were similar with pure COPD group,both didnot demonstrate significant differences.(P0.05)2. Clinical symptom and physical sign:The occurrence of syncope, asymmetric swelling of lower limbs in COPD+PE groupwere significant higher than pure COPD grou（pP0.01）.The occurrence of cough, chestpain, hemoptysis, dyspnea in COPD+PE group were similar with pure COPD group,there were no significant differences between them (P0.05).3. Auxiliary examinationresults: The incidence of deep venous thrombosis detected by LED in COPD+PE groupwas50%, pure COPD group in the incidence of DVT was14.8%, with significantdifference (P<0.01). The finding of SⅠQⅢTⅢsyndrome in EKG in COPD+PE group wassignificant higher than pure COPD group（P0.05）.The findings of T wave changesand sinus tachycardia did not with significant differences between the two groups（P0.05）.The level of Carbon dioxide (PaCO2) in arterial blood gas was significantlyreduced in COPD+PE patients (40.286.42mmHg) compared with the pure COPDpatients (62.188.76mmHg). The result of PO2in COPD+PE group was56.928.76mmHg, pure COPD patients was60.3110.54mmHg, no significantdifference between the two groups（P0.05）.The levels of plasma D-dimer were0.670.12ug/ml in COPD+PE group and0.380.07ug/ml in pure COPD group, alsowith significant difference (P<0.01). Conclusions1.The COPD patients are high-riskgroups of PE. When the COPD patients existing the following risk factors: previousvenous thromboembolism, malignancy, surgery within6weeks, immobilization time≥7days are more likely to be complicated with PE.2. The clinical features of COPD withPE patients are nonspecific. The AECOPD patients presenting with syncope or shock,absence of fever, presentation no cough or sputum change, physical exam revealsasymmetric swelling of lower limbs combined with risk factors, should be suspected ofcomplicated with PE.3. When the clnical symptoms of AECOPD patients become moreserious, the level of Carbon dioxide (PaCO2) do not rise fall instead and the hypoxemiaincorrected after therapy, the finding of SⅠQⅢTⅢsyndrome in EKG and the level of D-dimer elevated,these patients have a high probability of complicated with PE. Weshould arrange the next examination including CTPA/MRPA, V/Q scan, pulmonaryarterial angiography appropriate to make a definite diagnosis.4. In the setting of highclinical probability for PE with known COPD patients, clinicians should be carried outaccording with the diagnosis algorithm to suspicion and diagnose in order to improvethe early diagnosis rates.