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

Objectives:To investigate clinical characteristics of chronic obstructive pulmonary disease(COPD)complicated with pulmonary embolism(PE)through retrospective analysis comparing clinical data of COPD complicated with PE with acute exacerbation of uncomplicated COPD,To enhance the diagnostic consciousness of PE in patients with COPD and diagnose and treat timely,thus reducing the mortality.Methods:This trial is a retrospective clinical comparison research.We selected 129 acute exacerbation of COPD patients who were hospitalized in First Department of Respiratory Medicine,The Second Affiliated Hospital of Kunming Medical University from January 2015 to December 2015.Among them,64 patients were diagnosed with PE through CTPA(computed tomographic pulmonary angiography),as group COPD+PE,and 65 patients were excluded PE through CTPA,as uncomplicated COPD group.To compared the differences of risk factors(including age,sex,smoking,hypertension,diabetes,congestive heart failure,malignancy,immobilization/long-term bed and previous venous thromboembolism),clinical features(including cough,chest pain,hemoptysis,palpitation,dyspnea,syncope and deep venous thrombosis of the lower extremity),arterial blood gas(PaO2,PaCO2),fibrinogen(FIB),D-dimer(DD),cardiac troponin I(cTnI)and brain natriuretic peptide(BNP)between two groups.Differences between two groups were analyzed using the SPSS 20.0 statistics software.Results:1.Risk factors:There were no significant differences in age,sex,smoking,hypertension,diabetes and congestive heart failure between two groups(P>0.05).The differences of the incidence of malignancy,immobilization/long-term bed and previous venous thromboembolism between two groups were statistically significant(P<0.05),the COPD complicated with PE group was higher than uncomplicated COPD group.2.Clinical features:The occurrence of cough,chest pain,hemoptysis,palpitation and dyspnea did not differ significantly between two groups(P>0.05);The occurrence of syncope and deep venous thrombosis of the lower extremity in the COPD complicated with PE group was higher than the uncomplicated COPD group,and the differences between two groups were statistically significant(P<0.05).3.Auxiliary examination results:No significant difference was observed for the level of arterial partial pressure of oxygen(PaO2)in both groups(P>0.05);The level of arterial partial pressure of carbon dioxide(PaCO2)in the COPD complicated with PE group(40.11±10.96mmHg)significantly dropped compared to the uncomplicated COPD group(48.57±18.23mmHg).No significant difference was observed for the level of plasma fibrinogen in both groups(P>0.05);The level of plasma D-dimer was 2.40±2.18?g/ml in the COPD complicated with PE group and 1.61±1.42?g/ml in the uncomplicated COPD group,and the difference between two groups was statistically significant(P<0.05).No significant difference was observed for the level of plasma cTnl in both groups(P>0.05);The level of plasma BNP in the COPD complicated with PE group was higher compared to the uncomplicated COPD group,and the difference between two groups was statistically significant(P<0.05).Conclusions:1.COPD patients who have the following risk factors:previous VTE,malignancy and immobilization/long-term bed are more likely to be complicated by PE.2.The clinical features of COPD complicated with PE are nonspecific.The COPD patients presenting with syncope,detected DVT by lower extremity Doppler ultrasonography,should be suspected of being complicated by PE,especially for COPD patients concomitant with multiple PE risk factors.3.When the COPD patients whose dyspnea worsens precipitously,the level of arterial partial pressure of carbon dioxide(PaCO2)dropped compared to baseline values,and the level of D-dimer and BNP in plasma abnormally elevated,PE should be highly suspected.