Clinical Analysis Of 137 Pulmonary Thromboembolism Of Different Location

Objiective Analyze the difference of simplified pulmonary embolism severity index(sPESI),ultrasound cardiogram(UCG),Brain natriuretic peptides(BNP)test,myocardial enzymology test,blood gas analysis,blood routine test,coagulation function test,serum biochemistry tests in diagnosed pulmonary thromboembolism patients of different segments.Also explore and evaluate the specific value of guiding the diagnosis,treatment and risk assessment in PTE of different segments.Methods 137 pulmonary thromboembolism patients in the retrospective analysis were selected from the department of respiratory medicine,the second affiliated hospital of Kunming medical university from March 2014-June 2017.All the patients were diagnosed with CTPA within 24 hours,and conformed to the diagnostic criteria of the guide.Collected myocardial enzymology,NT-proBNP,blood routine test,coagulation function test,serum biochemistry tests,blood gas analysis and sPESI which were tested immediately when the patients in hospital.Ultrasound cardiogram(UCG)and CTPA were tested in the first 24 hours.According to the result,all the pulmonary embolism patients were divided into three groups:central pulmonary embolism(we classify labor or more central vessel as central pulmonary embolism),segmental pulmonary embolism,and subsegmental pulmonary embolism.Analyze all the clinical data of the three groups,find out whether there was statistical differences.And then did the correlation analysis about the sPESI and the other data.Above all the results,we would find out whether there was relationship between sPESI and groups.In the meantime,it would give us the direction of clinical assessment,diagnosis and treatment in pulmonary thromboembolism.Results There were no statistical differences in the age and sex at the three groups(p>0.05).The statistical differences were found in pulmonary arterial pressure(PAP),cTnT,N-proBNP,DD,PT and APTT.PAP was gradual decline from group A to group C.The comparison about PAP between three groups:the level in group A is significantly higher than group B or group C:group A 42(30.5-56.8),group B 38.5(30-50),group C 32(28-36),(p<0.05,fig 10).Plasma NT-proBNP levels was gradual decline from group A to group C:group A 843(95-4181),group B 316(98.5-1180),group C 156(39-541),(p<0.05,fig 8).Plasma cTnT was gradual decline from group A to group C:group A 0.013(0.007-0.04),group B 0.01(0.005-0.026),group C 0.008(0.004-0.02)(p<0.05,fig 10).Some data of the coagulation function had statistical differences,the level of DD was higher in group A:group A 3.9(1.5-8.6),group B 1.0(0.43-2.7),group C 1.4(0.67-4.12)(p<0.05,fig 10).The comparison of PT was significant in three groups,it was gradual decline from group A to group C:group A 13.9(12.8-15.5),group B 13.2(12.5-14.3),group C 13.1(12.5-14.1)(p<0.05,fig 10).Besides,the level of APTT in three groups was specially different,group C is significantly higher than group B or group A:group A 31.1(27.6-35.7),groupB 35.7(30.1-40),group C36.4(33.5-39.5)(p<0.05,fig 10).The comparison of sPESI statistical differences in three groups.(p<0.05,fig 11).There were no statistical differences in the rest of the data.In the correlation analysis about sPESI and the other data,the groups and sPESI had negative correlation(r=-0.17,p=0.03 8).It showed that they were positively correlated between sPESI and PAP,RAD,RVDd,cTnT,N-proBNP,PT,DD.Respectively,PAP(r=0.20,p=0.03),RAD(r=0.23,p=0.007),RVDd(r=0.27,p=0.002),cTnT(r=0.30,p=0),N-proBNP(r=0.27,p=0.001),PT(r=0.18,p=0.04),DD(r=0.18,p=0.03).the others didn't have correlation with sPESI.Conclusion 1.There was no statistical difference in vital signs,blood gas analysis,blood routine test,serum biochemistry tests in different sites of pulmonary embolism.2.The clinical data about right heart burden may help the diagnosis in different segments of pulmonary thromboembolism.3.The influence of coagulation function is more severe in centre.4.The risk stratification of PTE is relevant to the site of pulmonary embolism,which indicates the differences in embolization sites may useful for predicting the risks stratification of pulmonary embolism.