慢性阻塞性肺疾病急性加重病人发生肺栓塞的危险因素及Caprini血栓风险评估量表的应用研究  

Risk factors for pulmonary embolism in patients with acute exacerbations of chronic obstructive pulmonary disease and application of Caprini risk assessment scale

作　　者：程明琨[1] 王明 段长恩 付君静[1] CHENG Mingkun;WANG Ming;DUAN Changen;FU Junjing(Department of Critical Care Medicine,First Affiliated Hospital of Xinxiang Medical College,Weihui,Henan 453100,China;Department of Respiratory Critical Care,First Affiliated Hospital of Xinxiang Medical College,Weihui,Henan 453100,China;Cardiovascular Surgery,First Affiliated Hospital of Xinxiang Medical College,Weihui,Henan 453100,China)

机构地区：[1]新乡医学院第一附属医院重症医学科,河南卫辉453100 [2]新乡医学院第一附属医院呼吸重症科,河南卫辉453100 [3]新乡医学院第一附属医院心血管外科,河南卫辉453100

出　　处：《安徽医药》2022年第12期2508-2511,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的 探讨慢性阻塞性肺疾病急性加重(AECOPD)病人发生肺栓塞的危险因素及Caprini血栓风险评估量表的应用效果。方法 选择新乡医学院第一附属医院2018年3月至2019年2月AECOPD 153例作为研究对象,收集病人的临床资料,统计肺栓塞发生情况并通过统计学分析其危险因素。所有研究对象按照是否应用Caprini血栓风险评估量表分为两组,未评估组入院后常规临床干预,评估组接受Caprini血栓风险评估量表评估并以此结果为指导的临床干预,比较两组的肺栓塞发生情况。结果 研究中153例AECOPD病人发生肺栓塞30例,发生率为19.6%。单因素提示体质量指数(BMI)≥25 kg/m^(2)、有糖尿病史、既往静脉血栓史、有下肢水肿、卧床时间≥7 d、血二氧化碳分压≤36 mmHg、D-二聚体≥500μg/L、慢性阻塞性肺疾病(COPD)分级>Ⅱ级的病人肺栓塞发生率更高,分别为27.5%(22/80)、34.1%(14/41)、42.9%(9/21)、44.1%(15/34)、27.1%(23/85)、36.0%(18/50)、30.6%(19/62)、28.0%(21/75),与无以上因素的病人肺栓塞发生率11.0%(8/73)、14.3%(16/112)、15.9%(21/132)、12.6%(15/119)、10.3%(7/68)、11.7%(12/103)、12.1%(11/91)、11.5%(9/78)比较,差异有统计学意义(P<0.05)。多因素logistic回归分析提示病人BMI、糖尿病史、下肢水肿、卧床时间、血二氧化碳分压、D-二聚体、COPD分级是AECOPD病人发生肺栓塞的危险因素。评估组肺栓塞发生率为13.3%(11/83)、显著低于未评估组的27.1%(23/85)(P<0.05);评估组病人住院时间(17.6±4.9)d,显著短于未评估组的(21.3±4.2)d(P<0.001)。结论 AECOPD病人肺栓塞的发生受到BMI、糖尿病史、下肢水肿、卧床时间、血二氧化碳分压、D-二聚体、COPD分级多种危险因素影响,临床工作者可应用Caprini血栓风险评估量表对病人进行评估,以此为指导采取有效的干预措施,促进病人康复。Objective To investigate the risk factors for pulmonary embolism in patients with acute exacerbations of chronic obstructive pulmonary disease and application of Caprini risk assessment scale.Methods A total of 153 patients with acute exacerbations of chronic obstructive pulmonary disease from March 2018 to February 2019 in our hospital were selected as subjects,the clinical data of patients were collected,and the occurrence of pulmonary embolism was counted and the risk factors were statistically analyzed.All subjects were divided into two groups according to whether the Caprini risk assessment scale was used,and the patients in unevaluated group received routine clinical intervention after admission,the patients in evaluation group were evaluated by Caprini risk assessment scale and the clinical intervention guided by this result,the occurrence of pulmonary embolism of two groups was compared.Results In153 patients with acute exacerbations of chronic obstructive pulmonary disease,30 cases developed pulmonary embolism,the incidence rate was 19.6%.Single factor indicated that body mass index ≥25 kg/m^(2),diabetes history,previous venous thrombosis history,lower extremity edema,bed time ≥7 d,blood carbon dioxide partial pressure ≤36 mmHg,D-dimer>500 μg/L,chronic obstructive pulmonary disease(COPD) classification>Ⅱ in patients has higher incidence rate of pulmonary embolism,27.5%(22/80),34.1 %(14/41),42.9(9/21),44.1%(15/34),27.1%(23/85),36.0%(18/50),30.6%(19/62) and 28.0%(21/75),respectively,while those in patients without the above-mentioned factors were 11.0%(8/73),14.3%(16/112),15.9%(21/132),12.6%(15/119),10.3%(7/68),11.7%(12/103),12.1%(11/91) and 11.5%(9/78),the differences were statistically significant(P<0.05).Multivariate logistic regression analysis indicated that patient’s body mass index,diabetes history,lower extremity edema,bed rest time,blood carbon dioxide partial pressure,Ddimer and COPD classification were risk factors for pulmonary embolism in patients with acute exacerbations of chronic

关 键 词：肺疾病 慢性阻塞性 肺栓塞 嘧啶二聚物 调查和问卷 Caprini血栓风险评估量表 危险因素 

分 类 号：R563.9[医药卫生—呼吸系统]