慢性阻塞性肺疾病合并慢性肺栓塞患者的临床特点分析

目的分析COPD合并慢性肺栓塞患者的临床特征，加强对COPD患者中原位肺栓塞形成的认识，评价抗凝治疗在COPD中的应用价值，为基层医院提供COPD合并慢性肺栓塞的临床经验性诊断和治疗的依据。方法人选COPD合并肺栓塞患者53例，设为研究组，选取同期AECOPD患者70例设为对照组。对照分析两组患者的临床特征。观察研究组患者抗凝治疗的疗效。结果两组患者比较，血浆D-二聚体、双下肢静脉彩超差异无统计学意义（P〉0．05）；血红蛋白水平、6分钟步行试验、CAT评分、mMRC评分、PaCO2、PaO2、A—aD02、FEV，％pred、肺动脉压均有明显差异，差异有统计学意义（P〈0．05）。研究组患者经抗凝治疗后，上述指标有明显改善，血红蛋白及肺动脉压降低，但差异无统计学意义（P〉0．05），余指标治疗后改善，与治疗前比较差异均具有统计学意义（P〈0．05）。结论慢性肺栓塞是导致COPD患者出现顽固性低氧血症、活动能力差的重要因素，抗凝治疗对COPD合并慢性肺栓塞患者具有可靠的临床应用价值。

Analysis of the clinical characteristics of chronic obstructive pulmonary disease in patients with chronic pulmonary embolism

Objective Analysis the clinical features of chronic obstructive pulmonary disease （COPD） with chronic pulmonary embolism, to strengthen the understanding of the in situ pulmonary embolism in patients with COPD,to provide the clinical experience of diagnosis and treatment of COPD combined with chronic pulmonary embolism for basic-level hospitals. Methods We selected 53 COPD complicated with PE patients defined as research group, while selected 70 COPD patients in the same period defined as control group, compare the differences of clinical characteristics between the two groups. Observe the curative effect of the case group after anticoagulant therapy. Results There were no difference in D-dimmer and double lower limbs vein ultrasound between the two groups, but Hemoglobin levels,6 minutes walk test, CAT scores, mMRC score, PaCO2, PaO2, A-aDO2, FEV1% pred, pulmonary artery systolic pressure have obvious differences （P 〈0.05）. After anticoagulation, the above indexes were obviously improved. Conclusions Chronic pulmonary embolism is an important factor which causes stubborn hypoxemia and poor activity of COPD. Anticoagulant therapy has reliable clinical value for COPD combine with chronic pulmonary embolism.