非显性因素导致AECOPD住院患者合并肺栓塞的危险因素分析  

Risk Factors of Pulmonary Embolism in Hospitalized Patients with AECOPD Deduced by Non-dominant Factors

作　　者：李军华[1] 张仕国[1] 陈志勇[1] 刘春燕[1] 喻小菊 牟敏[1] 

机构地区：[1]四川省巴中市中心医院呼吸科,四川巴中636000

出　　处：《河北医学》2017年第3期491-495,共5页Hebei Medicine

基　　金：四川省卫生计划委员会资助项目;(编号:201403252)

摘　　要：目的:探讨非显性因素导致慢性阻塞性肺疾病急性加重(AECOPD)合并肺栓塞住院患者的危险因素,为临床诊治提供理论依据。方法:选取182例非显性因素导致AECOPD患者,按照患者肺动脉造影结果分为两组,肺栓塞组(60例)和无肺栓塞组(122例)。分析两组患者一般资料、既往病史、临床症状、COPD严重程度、检查结果,再采用Logistic回归分析非显性因素导致AECOPD危险因素。结果:对比两组患者一般资料、既往病史、COPD分级和临床症状,两组患者无显著差异,无统计学意义(均P>0.05)。肺栓塞组25.0%患者持续卧床超过1周,28.33%患者出现血二氧化碳分压小于等于基线值(36mmH g),36.67%患者出现双下肢周径差值大于等于1cm,98.33%患者出现D-二聚体大于等于500μg/L以及38.33%患者出现深静脉血栓,与无肺栓塞组相比,无肺栓塞组患者相关指标均优于肺栓塞组患者,差异具有统计学意义(均P<0.05)。经回归分析发现,卧床时间超过1周、深静脉血栓和双下肢周径相差1cm以上三个因素是非显性因素导致AECOPD合并肺栓塞的危险因素。结论:非显性因素导致AECOPD住院老年患者合并肺栓塞的危险因素主要有三个,分别是卧床时间超过1周、深静脉血栓和双下肢周径相差1cm,临床上应重视肺栓塞的可能,避免发生漏诊。Objective： To investigate the risk factors of pulmonary embolism（ PE） in patients with chronic obstructive pulmonary disease（ COPD） deduced by non-dominant factors in order to provide the basis for clinical treatment. Methods： 184 patients with AECOPD deduced by non-dominant factors in our hospital were selected and divided into two groups,60 patients in pulmonary embolism group and 122 patients in nonpulmonary embolism group. The past disease history,general information,auxiliary examination results,clinical symptoms and COPD severity grading of the two groups were compared. Then the risk factors were analyzed by Logistic regression analysis. Results： There was no statistically significant difference in the general information,COPD severity grading,past disease history and clinical symptoms of the two groups（ P 〉 0.05）. In the pulmonary embolism group,25.0% patients’ bed time was more than one week,36.67% patients’ difference of the two limb circumference was no less than 1cm,28. 33% patients’ PCO2 was no more than 36 mm Hg,38.33% patients had deep venous thrombosis,and 98.33% patients’ D Dimer was no less than 500μg/L. Compared with the pulmonary embolism group,the indexes of the non-pulmonary embolism group were significantly better than those of the pulmonary embolism group（ P 〈0.05）. According to the Logistic regression analysis,the time in bed more than one week,the difference of the two limbs circumference no less than 1cm,and deep venous thrombosis were the three main risk factors for AECOPD deduced by non-dominant factors. Conclusion： There are three main risk factors for AECOPD deduced by non-dominant factors including the time in bed more than one week,the difference of the two limbs circumference no less than 1cm,and deep venous thrombosis. The possibility of PE should be paid more attention to in order to avoid misdiagnosis.

关 键 词：肺栓塞 COPD 老年 危险因素 

分 类 号：R563[医药卫生—呼吸系统]