【摘要】 目的探讨血浆D-二聚体、B型钠尿肽和血气（PaO₂、PaCO₂）在高风险慢性阻塞性肺疾病急性加重期（AECOPD）继发肺栓塞（PTE）的预测价值。方法选取于2016年1月至2017年12月期间在我院住院的32例高风险AECOPD继发PTE的患者作为血栓组;同期住院60例高风险AECOPD未继发PTE的患者为高风险单纯COPD组;另选择同期住院的52例低风险AECOPD（未继发PTE）患者为低风险COPD组。对所有入选的患者行血浆D-二聚体、B型钠尿肽（BNP）及血气分析检查并进行对比分析。结果高风险AECOPD患者（血栓组和高风险单纯COPD组）的血浆D-二聚体、BNP的均值均高于低风险COPD组患者,血栓组患者血浆D-二聚体均值又高于高风险单纯COPD组患者,差异均具有统计学意义（P<0.05）。血栓组患者的PaCO₂及PaO₂均值均低于高风险单纯COPD组及低风险COPD组患者,差异均具有统计学意义（P<0.05）。高风险单纯COPD组患者PaCO₂高于低风险COPD组患者（P<0.05）,但两组间PaO₂均值差异无统计学意义。结论高风险AECOPD患者的血浆D-二聚体、BNP水平升高,低氧血症、二氧化碳潴留,继发肺栓塞时,D-二聚体及BNP升高更明显,低氧进一步加重,且在原有高二氧化碳水平的基础上出现PaCO₂下降,均值>5 mm Hg,提示血浆D-二聚体、BNP与血气分析检测在判断高风险AECOPD继发肺栓塞的风险中有较高的预测价值,能为临床及时判断高风险AECOPD患者早期抗凝治疗提供重要的依据。更多还原

【Abstract】 Objective To investigate the predictive value of plasma D-dimmer,B-type natriuretic peptide（ BNP） and blood gas indexes in secondary pulmonary thromboembolism（ PTE） during the high-risk of acute exacerbation of chronic obstructive pulmonary disease（ AECOPD）. Methods A total of 32 patients with high-risk AECOPD + secondary PTE,treated in our hospital from January 2016 to December 2017,were collected as the thrombosis group,60 patients with high-risk of AECOPD without secondary PTE,treated at the same period,were selected as the simple high-risk COPD group,and 52 patients with low-risk COPD during the period of acute exacerbation（ without secondary PTE）,treated at the same period,were selected as the low-risk COPD group. The plasma D-dimmer,BNP,and blood gas indexes [the arterial partial pressure of oxygen（ PaO₂） and the arterial partial pressure of carbon dioxide（ PaCO₂） ]were detected and analyzed in all the patients. Results The mean values of plasma D-dimmer and BNP in the thrombosis group and the simple high-risk COPD group were higher than those of the low-risk COPD group. The mean value of plasma D-dimmer in the thrombosis group was higher than that of the high-risk COPD group,and statistical significant differences were found between the two groups（ P<0.05）. The PaCO₂ and PaO₂ in the thrombosis group were lower than those of the simple high-risk COPD group and the low-risk COPD group,and statistical significant differences were found between the two groups（ P<0.05）. The patients with simple high-risk COPD had higher PaCO₂ than the patients with low-risk COPD（ P<0.05）,however,there was no statistical significant difference in the mean PaO₂ between the two groups. Conclusion In the patients with high-risk AECOPD,the plasma D-dimmer and BNP levels are elevated,and hypoxemia and carbon dioxide retention occur. When combined with pulmonary thromboembolism,the D-dimmer and BNP levels increase more significantly,the symptoms of hypoxia are further aggravated. And on the basis of original high carbon dioxide,there is a decrease in the PaCO₂,with a mean value greater than 5 mm Hg,suggesting that the plasma D-dimmer,BNP,and blood gas analysis tests have a good predictive value in judging the high-risk AECOPD associated with pulmonary embolism. It can provide an important basis for early clinical anticoagulant therapy for the patients with acute exacerbation of high-risk COPD.更多还原