Analysis Of Clinical Characteristics Of Patients With Pulmonary Embolism After Cesarean Section

Objective:To analyze the general data,complications and auxiliary examination data of patients with pulmonary embolism 1 week after cesarean section and non-pulmonary embolism patients after cesarean section,and explored the clinical characteristics of patients with pulmonary embolism after cesarean section.Related risk factors to facilitate early clinical identification of interventions and improve patient prognosis.Methods:A retrospective analysis of 95 cases of parturients who completed pulmonary artery CT scans in the Department of Respiratory and Critical Care Medicine and Obstetrics of the Second Affiliated Hospital of Kunming Medical University from January 2016 to June 2020.Embolism group(n=41 cases)and non-pulmonary embolism group(n=54 cases).Collect the age,gender,BMI,parity,twin or multiple pregnancies,IVF,vital signs,clinical symptoms(fever,hemoptysis,dyspnea,chest pain,cough,syncope,lower extremity swelling and pain),laboratory indicators(Coagulation function,liver enzyme index,blood cell analysis,acute infection,etc.),comorbidities(preeclampsia,postpartum hemorrhage,postpartum infection,pleural effusion,placenta previa,etc.,of which postpartum infections include urinary tract infections).A stepwise binary logistic regression model was used to finally determine the independent risk factors for pulmonary embolism after cesarean section.The receiver operating characteristic(ROC)curve was used to study the best cut-off value of D-dimer in the diagnosis of pulmonary embolism after cesarean section.Results:1.In the comparison of general information and vital signs of the two groups of patients,there was no statistically significant difference in age,BMI,twin or multiple pregnancies,parity>1,IVF,body temperature,respiration,systolic blood pressure,and diastolic blood pressure(P>0.05);the heart rate of the pulmonary embolism group after cesarean section(89.37±14.56)was significantly lower than that of the non-pulmonary embolism group(98.85±16.27)after cesarean section,the difference was statistically significant(P<0.05).2.In the comparison of the clinical symptoms of the two groups of patients,the incidence of fever,hemoptysis,chest pain,cough,syncope,and lower limb swelling and pain were not statistically significant(P>0.05);dyspnea in the pulmonary embolism group after cesarean section The incidence rate(65.9%)was significantly higher than that in the non-pulmonary embolism group(29.6%)after cesarean section,and the difference was statistically significant(P<0.001).3.In the comparison of comorbidities between the two groups,the incidence of postpartum infection in the pulmonary embolism group after cesarean section was higher than that in the non-pulmonary embolism group after cesarean section,and the difference was statistically significant(P<0.05);postpartum hemorrhage There were no statistically significant differences in the incidence of placenta previa,preeclampsia,and pleural effusion(P>0.05).4.Comparison of the coagulation function of the two groups of patients,the PT and DD of the pulmonary embolism group after cesarean section were higher than those of the non-pulmonary embolism group after cesarean section,the difference was statistically significant(P<0.05).5.Comparison of liver enzyme indexes between the two groups,the ALT after cesarean section pulmonary embolism group was higher than that of non-pulmonary embolism group after cesarean section,the difference was statistically significant(P<0.05).6.Comparing the three indicators of acute infection between the two groups,the Hs-CRP of the pulmonary embolism group after cesarean section was higher than that of the non-pulmonary embolism group after cesarean section,the difference was statistically significant(P<0.05).7.There was no significant difference between the two groups of patients with myocardial injury markers(cTNT,MYO,NTproBNP,CK-MB,CK)(P>0.05).8.Correlation analysis of various factors and pulmonary embolism after cesarean section showed that heart rate,BMI>25Kg/m2,postpartum infection,PT,DD and pulmonary embolism after cesarean section were significantly correlated(P<0.05),postpartum infection,PT,DD are positively correlated with pulmonary embolism after cesarean section,heart rate,BMI>25Kg/m2 are negatively correlated with pulmonary embolism after cesarean section,the correlation is weak(| r|<0.4),the result was statistically significant(P<0.05).9.Multivariate logistic regression analysis showed that postpartum infection(OR=3.649,P=0.026),DD(OR=1.400,P=0.005),PT(OR=1.601,P=0.042)were 1 week after cesarean section The independent influencing factors of pulmonary embolism,the difference was statistically significant(P<0.05).10.DD,PT,ALT,Hs-CRP have a certain diagnostic value for pulmonary embolism one week after cesarean section.Their AUC and 95%CI are 0.643(0.525-0.761),0.626(0.521-0.723),respectively.0.637(0.532-0.733),0.630(0.525-0.727);the corresponding optimal cut-off value is 3.89ug/ml,12.1s,10U/L,9.05mg/L;at this time DD5 PT,ALT,Hs-CRP The sensitivity and specificity for diagnosing pulmonary embolism 1 week after cesarean section were(41.5%,90.7%),(58.54%,68.52%),(80.49%,44.44%),(73.2%,55.6).Conclusions:1.Patients with postpartum infection one week after cesarean section are more likely to have pulmonary embolism;and postpartum infection is an independent risk factor for pulmonary embolism one week after cesarean section.2.Patients with pulmonary embolism 1 week after cesarean section had higher PT,DD,ALT,Hs-GRP than non-pulmonary embolism group.3.DD,PT,ALT,Hs-CRP have certain predictive value for pulmonary embolism 1 week after cesarean section.