Akgun Metin, Meral Mehmet, Onbas Omer, Araz Omer, Koplay Mustafa, Aslan Sahin, Mirici Arzu
Department of Chest Disease, School of Medicine, Ataturk University, Erzurum, Turkey.
Respiration. 2006;73(4):428-33. doi: 10.1159/000092952. Epub 2006 Apr 21.
Although some studies evaluated venous thromboembolism (VTE) prevalence in patients with chronic obstructive pulmonary disease (COPD), they contain no detailed description of the patients' characteristics.
It was the aim of this study to investigate the frequency and clinical characteristics and outcomes of VTE in patients with COPD exacerbation.
Between October 2004 and February 2005, 120 consecutive patients were included in the study. On admission, Doppler examination of lower extremities in all cases and spiral computed tomography of the thorax in cases with a suspicion of pulmonary thromboembolism were performed. A questionnaire was used to take a detailed history. In addition to routine laboratory tests, chest X-ray, postbronchodilator spirometry, arterial blood gas analysis and serum levels of D-dimer and C-reactive protein were evaluated, as well as dyspnea score and performance status before exacerbation. The hospitalization durations and mechanical ventilation requirements were also recorded.
VTE was determined in 16 cases (13.3%). In patients with VTE, the travel history was higher (p < 0.001), the dyspnea score worse (p = 0.005), the duration of hospitalization longer (p < 0.001) and the mechanical ventilation requirement increased (p < 0.001); a change in mental status was highly associated with the presence of VTE (p < 0.001).
It seems that VTE occurrence was higher in the presence of a risk factor causing immobility such as travel history and increased dyspnea. The cases with severe disease are more likely to have VTE. Preventive measures may be considered in such patients because their hospitalization stay and mechanical ventilation requirement are increased.
尽管一些研究评估了慢性阻塞性肺疾病（COPD）患者静脉血栓栓塞症（VTE）的患病率，但这些研究并未详细描述患者的特征。
本研究旨在调查慢性阻塞性肺疾病急性加重期患者VTE的发生率、临床特征及预后。
2004年10月至2005年2月，连续纳入120例患者。入院时，对所有患者进行下肢多普勒检查，对疑似肺血栓栓塞症的患者进行胸部螺旋计算机断层扫描。使用问卷详细询问病史。除常规实验室检查外，还评估胸部X线、支气管扩张剂后肺功能、动脉血气分析、D - 二聚体和C反应蛋白的血清水平，以及急性加重前的呼吸困难评分和体能状态。记录住院时间和机械通气需求。
16例（13.3%）患者确诊为VTE。VTE患者的旅行史较多（p < 0.001），呼吸困难评分较差（p = 0.005），住院时间较长（p < 0.001），机械通气需求增加（p < 0.001）；精神状态改变与VTE的存在高度相关（p < 0.001）。
在存在导致活动受限的危险因素（如旅行史和呼吸困难加重）的情况下，VTE的发生率似乎更高。重症患者更易发生VTE。鉴于此类患者住院时间延长和机械通气需求增加，可考虑采取预防措施。
