Clinical Analysis Of Patients With Acute Intermediate Risk Pulmonary Thromboembolism

Objective: To explore the basis of risk the stratification of acute intermediate risk Pulmonary Thromboembolism(PTE).To evaluate the efficacy and safety of different treatment modalities for intermediate-high risk PTE.Methods: The clinical data of 66 patients with intermediate-high risk PTE and 34 patients with intermediate-low risk PTE who were hospitalized in Hunan Provincial People’s Hospital from January 2018 to January 2021 were retrospectively analyzed.The general data,risk factors,associated diseases,clinical symptoms,biochemical indexes and imaging data of the two groups were compared.According to different treatment methods,the patients with intermediate-high risk PTE were divided into thrombolytic group(n=20)and anticoagulant group(n=46).The thrombolytic group received 50 mg alteplase thrombolytic sequence anticoagulant therapy,and the anticoagulant group received anticoagulant therapy alone.The efficacy,safety and economic benefits of the two groups were compared.Results:1.The major risk factors for patients with acute intermediate-risk PTE were surgery,trauma and braking history,followed by the smoking history.More than half of the patients complicated with Deep Venous Thrombosis(DVT).The most common clinical symptoms were dyspnea.Biochemical indexes showed significant differences in erythrocyte sedimentation rate,troponin I,oxygenation index,N-terminal pro brain natriuretic peptide in patients with acute intermediate-high risk PTE compared with the patients with acute intermediate-low risk PTE.The results of echocardiography showed that there were statistically significant differences in Right Ventricular end diastolic diameter/Left Ventricular end diastolic diameter(RV/LV),tricuspid regurgitant velocity,pulmonary artery systolic pressure and main pulmonary artery diameter between patients with acute intermediate-high risk PTE and patients with intermediate-low risk PTE.The results of Computed Tomography Pulmonary Angiography(CTPA)showed that the thrombus load,RV/LV and the main pulmonary artery diameter in patients with acute intermediate-high risk PTE were significantly higher than those with acute intermediate-low risk PTE(P<0.05).2.The results of multivariate binary Logistic regression analysis showed that oxygenation index,pulmonary artery systolic pressure and thrombus load were independent related factors affecting the risk stratification of acute intermediate risk PTE(P<0.05).Among them,oxygenation index was negatively correlated with the risk stratification,while pulmonary artery systolic pressure and thrombus load were positively correlated with the risk stratification.3.Receiver Operating Characteristic(ROC)curve analysis showed that the area under the curve for the combination of oxygenation index,pulmonary artery systolic pressure and thrombus load to predict the risk layer of acute intermediate risk PTE was 0.82(95%CI 0.74-0.90),the sensitivity was75.76%,the specificity was 76.47%,the positive predictive value was86.21%,and the negative predictive value was 61.91%.4.The efficacy analysis of intermediate-high risk PTE patients showed that the thrombolysis group had higher efficiency and lower inefficiency than the anticoagulant group(P<0.05).In terms of safety analysis,there was no significant difference in bleeding risk between the two groups.In terms of economic benefit,there was no significant difference in the total hospital stay and total cost between the two groups.Conclusion:1.Oxygen index,pulmonary artery systolic pressure and thrombus load are independent related factors affecting the risk stratification of acute intermediate risk PTE,and can be used as a powerful supplement to the risk stratification of acute intermediate risk PTE.The combination of three indicators was the best predictor of acute intermediate risk PTE risk stratification.2.The short-term curative effect of 50 mg alteplase thrombolytic therapy for acute intermediate-high risk PTE patients is good,and it does not increase the risk of bleeding and economic burden,and can be used as a clinical treatment option.