慢性阻塞性肺疾病急性加重患者肺栓塞的危险因素及Caprini血栓风险评估量表的预测价值

目的: 分析慢性阻塞性肺疾病急性加重（acute exacerbation of chronic obstructive pulmonary disease，AECOPD）患者发生肺栓塞的危险因素，探讨Caprini血栓风险评估量表对AECOPD肺栓塞的预测价值。方法: 选择住院的AECOPD合并肺栓塞患者218例作为肺栓塞组，同期入院的AECOPD无肺栓塞患者126例作为对照组。采用Logistic回归分析探究影响AECOPD住院患者发生肺栓塞的危险因素。比较两组Caprini评分，探讨Caprini评分与AECOPD肺栓塞发病风险的关系。结果： 肺栓塞组糖尿病、恶性肿瘤史、下肢外伤史、6周内手术史、脑血管意外史、长期卧床等发生率均明显高于对照组（P0.05）。糖尿病史、恶性肿瘤史、6周内手术史、下肢外伤史、脑血管意外史、长期卧床均为肺栓塞发生的独立危险因素（P<0.05）。肺栓塞组患者Caprini评分显著高于对照组（P<0.05）。肺栓塞组患者极高危117例(53.67%)，高危53例(24.31%)，高危及以上合计占77.98%。对照组患者中高危66例(52.37%)，低危36例（28.57%）。两组患者危险度分级的构成比差异有统计学意义（P<0.05）。Caprini危险度分级为极高危和高危的AECOPD患者为肺栓塞的高危人群。随Caprini危险度分级的升高，患者肺栓塞的发病风险明显增加（P<0.05）。 结论： AECOPD住院患者肺栓塞的危险因素为糖尿病史、恶性肿瘤史、6周内手术史、下肢外伤史、脑血管意外史、长期卧床等。Caprini血栓风险评估量表可用于评估AECOPD肺栓塞病情和预后。

Risk factors of pulmonary embolism in patients with AECOPD and predictive value of Caprini thrombosis risk assessment scale

Objective: To analyze the risk factors of pulmonary embolism in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD), and to explore the predictive value of Caprini thrombosis risk assessment scale on AECOPD pulmonary embolism.Methods: A total of 218 patients with AECOPD and pulmonary embolism were selected as observation group, and a total of 126 patients with AECOPD but without pulmonary embolism at the same time period were selected as control group. Logistic regression analysis was used to investigate the risk factors for pulmonary embolism in hospitalized patients with AECOPD. The Caprini score was compared between the two groups, and the relationship between Caprini score and risk of AECOPD pulmonary embolism was explored.Results: The incidences of diabetes, malignant tumor, lower extremity trauma, surgery within 6 weeks, cerebrovascular accident, and prolonged bed rest were significantly higher in the observation group than those in the control group(P0.05). History of diabetes mellitus, history of malignant tumor, history of surgery within 6 weeks, history of lower extremity trauma, history of cerebrovascular accident and long term bedridden were independent risk factors for pulmonary embolism(P<0.05). The Caprini score in observation group was significantly higher than that in control group(P<0.05). In observation group, 117 patients(53.67%) were at extremely high risk and 53 patients(24.31%) were at high risk, and the proportion of high risk and above accounted for 77.98%. In control group, 66 patients(52.37%) were at moderately high risk and 36 cases(28.57%) were at low risk. There was a statistically significant difference in the composition ratio of risk grades between the two groups(P<0.05). Caprini risk is classified as a high risk and high risk AECOPD patient at high risk for pulmonary embolism. With the increase of Caprini risk grades, the risk of pulmonary embolism was significantly increased(P<0.05). Conclusion: The risk factors for pulmonary embolism in patients with AECOPD are history of diabetes mellitus, history of malignant tumor, history of surgery within 6 weeks, history of lower extremity trauma, history of cerebrovascular accident and long term bedridden. The Caprini thrombosis risk assessment scale can be used for AECOPD pulmonary embolism and prognosis assessment.