Schönhofer B, Köhler D
Krankenhaus Kloster Grafschaft, Zentrum für Pneumologie, Beatmungs- und Schlafmedizin, Schmallenberg-Grafschaft, Germany.
Respiration. 1998;65(3):173-7. doi: 10.1159/000029254.
Acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with dyspnea and, consequently, reduced mobility. Immobility is a recognized risk factor of deep-vein thrombosis (DVT), but few data exist regarding the prevalence of DVT in patients with acute exacerbation of COPD. Real-time B-mode ultrasonography (US) is a noninvasive screening method for the diagnosis of DVT. We therefore used US to investigate the prevalence of DVT in patients with an acute exacerbation of COPD. In a prospective cohort study, 196 patients with COPD were studied [110 males, 86 females, age: 66.9 +/- 9.1 years, weight: 63.5 +/- 12.7 kg, forced expiratory volume in 1 s (FEV1): 0.7 +/- 0.2 liters, and a ratio of FEV1 to vital capacity (VC): 37 +/- 6%] in a respiratory intensive care unit on the day of admission. Patients with reduced mobility due to other disease were excluded. All US were performed by one experienced person with a 5-MHz linear scanner. The views of the lower extremity were subdivided into three segments: (1) the common femoral, (2) superficial femoral veins including the long saphenous vein and (3) the popliteal vein. In 21 of 196 COPD patients (10.7%), DVT were demonstrated; 18 of these were asymptomatic. Bilateral DVT were not found. In 6 patients, additional diagnoses were: Baker's cyst (n = 3), inguinal lymph node (n = 1) and knee joint effusion (n = 2). There were no differences between patients with and with DVT with respect to age, hemoglobin, PO2, PCO2, pH, FEV1, VC or dyspnea scale. DVT in the lower extremity, which was not detectable on clinical examination, was relatively common in patients with an acute exacerbation of COPD. All clinical variables measured (age, weight, dyspnea scale, lung function, hemoglobin, hematocrit and blood gases) failed to predict patients more likely to have DVT.
慢性阻塞性肺疾病（COPD）急性加重期与呼吸困难相关，进而导致活动能力下降。活动减少是深静脉血栓形成（DVT）公认的危险因素，但关于COPD急性加重期患者DVT患病率的数据较少。实时B型超声检查（US）是诊断DVT的一种非侵入性筛查方法。因此，我们采用US来调查COPD急性加重期患者DVT的患病率。在一项前瞻性队列研究中，对196例COPD患者进行了研究[110例男性，86例女性，年龄：66.9±9.1岁，体重：63.5±12.7kg，1秒用力呼气量（FEV1）：0.7±0.2升，FEV1与肺活量（VC）之比：37±6%]，于入院当天在呼吸重症监护病房进行。排除因其他疾病导致活动减少的患者。所有US检查均由一名经验丰富的人员使用5MHz线性扫描仪进行。下肢检查部位分为三个节段：（1）股总静脉，（2）包括大隐静脉的股浅静脉，（3）腘静脉。196例COPD患者中有21例（10.7%）显示存在DVT；其中18例无症状。未发现双侧DVT。6例患者有其他诊断结果：腘窝囊肿（n = 3）、腹股沟淋巴结（n = 1）和膝关节积液（n = 2）。有DVT和无DVT的患者在年龄、血红蛋白、PO2、PCO2、pH、FEV1、VC或呼吸困难量表方面无差异。下肢DVT在临床检查中无法检测到，在COPD急性加重期患者中相对常见。所测量的所有临床变量（年龄、体重、呼吸困难量表、肺功能、血红蛋白、血细胞比容和血气）均无法预测更可能发生DVT的患者。
