Chronic Obstructive Pulmonary Disease With Pulmonary Embolism Risk Factors And Diagnosis Of Clinical Research

Objective: To explore the risk factors and clinical scoring methods of pulmonary embolism(PE)with chronic obstructive pulmonary disease(COPD).For high-risk patients in a timely manner to take clinical diagnostic evaluation to reduce the rate of missed pulmonary embolism in COPD patients.Methods: In this study,we reviewed 2771 inpatients with chronic obstructive pulmonary disease(COPD)from January 2010 to January 2017 in the First Affiliated Hospital of China Medical University and 115 patients underwent pulmonary angiography.Among them,44 cases diagnosed pulmonary embolism by pulmonary arteriography were the observation group,and 71 cases without pulmonary embolism were the control group.The clinical data of two groups were compared,and the multiple regression analysis was used to find the risk factors of chronic obstructive pulmonary embolism.The original and modified Geneva scores and Wells scores were used for both groups.Results: 1.The 115 patients with arterial angiography,44 had pulmonary embolism,accounting for 38.26%(44/115).Compared with the simple COPD group,the COPD patients' age,average length of stay,sex,case fatality rate,acute exacerbation of chronic obstructive pulmonary disease,cardiac insufficiency,respiratory failure,deep venous thrombosis of the lower extremities,previous pulmonary embolism or Venous thrombosis,bed time ? 3 days,cough and phlegm,fever,chest pain,palpitations,procalcitonin,brain natriuretic peptide,oxygenation index there was a significant difference(P <0.05).2.Binary logistic regression analysis showed that the lower extremity deep vein thrombosis(OR = 94.593,95% CI: 9.321-959.960,P <0.001),previous pulmonary embolism or venous thrombosis(OR = 17.810,95% CI: 1.468-216.093(OR = 6.464,95% CI: 1.727-24.194,P <0.05),chest pain(OR = 10.404,95% CI: 2.532-42.747,P <(OR = 4.240,95% CI: 1.051-17.17,P <0.05)and type I respiratory failure(OR = 12.222,95% CI: 1.777-84.083,P <0.05)are risk factors for pulmonary embolism in patients with chronic obstructive pulmonary disease.3.The the original and modified Wells score was significantly different between the original and modified Geneva scores(P <0.05)for the two groups of patients.From the ROC curve analysis of the score line: Wells scores were greater than the Geneva score.the area under the curve of the original Wells score was the largest(0.815,95% CI : 0.733-0.896,P <0.001,corresponding score 4.25,sensitivity0.705,specificity 0.789).Conclusions: 1.Males,older age,deep vein thrombosis of the lower extremities,previous pulmonary embolism,or venous thrombosis increase the risk of pulmonary embolism in COPD patients.2.COPD patients with cough and sputum,chest pain,cardiac insufficiency,and type I respiratory failure should be alert to the possibility of pulmonary embolism.3.Geneva score,Wells score can evaluate the possibility of pulmonary embolism in COPD patients.The study recommended the original Wells score,when the score ? 4.25 points,the possibility of pulmonary embolism is extremely high.