ObjectiveTo investigate the safety and efficacy of intermittent pneumatic compression (IPC) in the treatment of deep venous thrombosis (DVT). MethodsThe clinical data of 496 patients with DVT who were treated in our hospital from January 2010 to October 2014 were analyzed retrospectively, to compare the time of venous pressure decreased to normal (T1) and time of circumference difference decreased to normal (T2) in patients received pure therapy (control group) and pure therapy combined with IPC (combination group), according to different types of patients in acute, sub-acute, and chronic phase. In addition, comparison of the remission rate of pulmonary embolism (PE), incidence of PE, and recurrence of DVT was performed between the control group and combination group too. Results① For DVT patients in acute stage, the time of T1 and T2 of patients in central type, peripheral type, and mixed type who received anticoagulant therapy/systemic thrombolysis/catheter thrombolysis+IPC, were significantly shorter than those patients who received only anticoagulant therapy/systemic thrombolysis/catheter thrombolysis (P<0.05). For DVT patients in sub-acute stage, the time of T1 and T2 of patients in central type and mixed type who received anticoagulant therapy/systemic thrombolysis+IPC, were significantly shorter than those of patients who received only anticoagulant therapy/systemic thrombolysis (P<0.05), the time of T1 of patients in peripheral type who received anticoagulant therapy/systemic thrombolysis+IPC, were significantly shorter than those of patients who received only anticoagulant therapy/systemic thrombolysis (P<0.01), but the time of T2 of patients in peripheral type didn't differed between patients who received only anticoagulant therapy/systemic thrombolysis and anticoagulant therapy/systemic thrombolysis +IPC (P>0.05). For DVT patients in chronic stage, the time of T1 and T2 of patients in central type and mixed type didn't differed between patients who received only anticoagulant therapy and anticoagulant therapy +IPC (P>0.05); the time of T1 of patients in peripheral type who received anticoagulant therapy+IPC, were significantly shorter than those of patients who received only anticoagulant therapy (P<0.05), but the time of T2 didn't differed with each other (P>0.05). ② There were 63 patients in control group and 47 patients in combination group had PE before treatment. After the treatment, the PE symptom of control group relieved in 56 patients (88.89%, 56/63) and maintained in 7 patients (11.11%, 7/63), the symptom of combination group relieved in 44 patients (93.62%, 44/47) and maintained in 3 patients (6.38%, 3/47), so the remission rate of PE symptom in combination group was higher (P<0.05). There were 6 patients suffered from new PE in control group[4.26% (6/141)] and 0 in combination group[0 (0/245)] after treatment in patients who hadn't PE before treatment, and the incidence of PE was lower in combination group (P<0.05). ③ There were 325 patients were followed up for 3-36 months with the median time of 27 months, including 157 patents in control group and 168 patients in combination group. During the follow-up period, 74 patients recurred[47.13% (74/157)] in control group and 46 patients recurred[27.38% (46/168)] in combination group, and the recurrence rate was lower in combination group (P<0.05). In addition, 41 patients suffered from post-thrombotic syndrome[26.11% (41/157)] in control group and 27 patients[16.07% (27/168)] in combination group, and the incidence of post-thrombotic syndrome was lower in combination group (P<0.05). ConclusionsIPC can significantly shorten the time of venous pressure and the circumference difference decreased to normal for DVT patients in acute stage and majority DVT patients in sub-acute stage, and it can relieve the clinical symptoms of PE, reduce the incidence rate of PE and recurrence rate of DVT. Therefore, IPC is a safe, reliable, and effective treatment for DVT patients in acute stage and majority DVT patients in sub-acute stage.
Objective To assess the predictive value of alveolar dead space fraction ( ADSF) for severity and reperfusion of acute pulmonary embolism( APE) . Methods 39 consecutive patients with APE were enrolled in a perspective study from July 2004 to March 2007. All patients were divided into a large pulmonary embolism group ( LPE) and a small pulmonary embolism group ( SPE) based to the mass and location of the embolus. The patients of the LPE group received thrombolytic therapy and anticoagulation,while the patients of the SPE group received anticoagulation only. CTPA or lung scintigraphy was performed before and after treatment to confirm the resolve condition of the embolism after treatment. Pressure of endexpired carbon dioxide ( PETCO2 ) and blood gas analysis ( including PaCO2 ) were measured at the time of run-in and 30 days after treatment by bedside. ADSF was calculated by PET CO2 and PaCO2 . Results Among 39 APE patients, there were 18 patients in the LPE group, while 21 in the SPE group. The ADSF of the LPE group before treatment were higher than that of the SPE group ( 0. 34 ±0. 078 vs. 0. 18 ±0. 027,P lt;0. 05) . The ADSF decreased significantly after treatment in the patients with full reperfusion ( 0. 09 ±0. 04 vs. 0. 28 ±0. 11, P lt;0. 01) . Conclusion As a bedside test, ADSF can reflect the mass of embolism and the reperfusion condition, and is useful in monitoring the disease.
Objective To investigate whether antipsychotic drugs will increase the risk of venous thromboembolism (VTE) and pulmonary embolism (PE), and to provide evidence for the prevention of VTE and PE in patients with APs exposure. Methods Databases including PubMed, Web of Science, CNKI, VIP and Elsevier were searched from inception to July 2016 to collect case-control studies and cohort studies on the association between APs exposure and the risk of VTE and PE. The literature were screened according to the inclusion and exclusion criteria, the data were extracted and the bias risk of the included studies were evaluated by two reviewers independently. The Meta-analysis was performed by using Stata 12 software. Results Nineteen studies were included. The results of meta-analysis showed that APs exposure was associated with VTE (OR=1.50, 95%CI 1.30 to 1.74,P<0.001). Exposure to low-potency FGA (OR=2.28, 95%CI 1.02 to 5.10,P=0.045), high-potency FGA (OR=1.68, 95%CI 1.37 to 2.05,P<0.001) and SGA (OR=1.74, 95%CI 1.24 to 2.44,P=0.001) revealed an increased risk of VTE. Exposure to APs also signi?cantly increase the risk of PE (OR=3.69, 95%CI 1.23 to 11.07,P=0.02), especially exposure to FGA (OR=2.54, 95%CI 1.22 to 5.32,P=0.013), but exposure to SGA could not revealed an increased risk of PE. Conclusion FGA and SGA exposure maybe associated with an increase in the risk of developing VTE. And exposure to the FGA could increase the risk of PE. The occurrence of VTE and PE should be monitored when taking Aps.
Abstract: Objective To retrospectively compare the difference of the effects of pulmonary thromboendarterectomy (PTE) between distal and proximal types of chronic thromboembolic pulmonary hypertension (CTEPH). Methods The data of 70 patients (including 44 male patients and 26 female patients, the average age was 46.2 years old, ranging from 17 to 72) with CTEPH having undergone PTE from March 2002 to March 2009 in Anzhen Hospital were retrospectively reviewed. We classified them into two different groups which were the proximal CTEPH group (n=51) and the distal CTEPH group (n=19) according to the pathological classification of the CTEPH. Clinical data, hemodynamics blood gas analysis and so on of both groups were compared. Results There was no perioperative deaths in both groups. Compared with the proximal group, cardiopulmonary bypass time [CM(159mm](189.5±41.5 min vs.155.5±39.5 min,P=0.003), aorta cross clamp time (91.3±27.8 min vs.67.2±27.8 min,P=0.002) and DHCA time (41.7±14.6 min vs.25.7±11.6 min,P=0.000) were significantly longer in the distal group. The incidence of residual pulmonary hypertension in the distal group was significantly higher than that in the proximal group (42.1% vs.13.7%,P=0.013), while the incidence of pulmonary reperfusion injury postoperatively in the proximal group was significantly higher than that in the distal group (41.2% vs.10.5%, P=0.021). SwanGanz catheterization and blood gas index were obviously improved in both groups. However, the pulmonary artery systolic pressure (PASP, 67.8±21.3 mm Hg vs.45.5±17.4 mm Hg,P=0.000) and the pulmonary vascular resistance ［PVR, 52.8±32.1 kPa/(L·s) vs.37.9±20.7 kPa/(L·s),P=0.024］ in the distal group were significantly higher than those in the proximal group and the partial pressure of oxygen in arterial blood of the distal group was significantly lower than that of the proximal group (76.7±8.7 mm Hg vs.88.8±9.3 mm Hg,P=0.000). After operation, 70 patients were followed up with no deaths during the followup period. The time of the followup ranged from 2 to 81 months (32.7±19.6 months) with a cumulative followup of 191.8 patientyears. Three months after operation, 47 patients were examined by pulmonary artery computer tomography angiogram (PACTA) and isotope perfusion/ventilation scan, which showed that the residual occlusive pulmonary artery segment in the proximal group was significantly fewer than that in the distal group (isotope perfusion/ventilation scan: 2.2±11 segments vs. 4.7±2.1 segments, P=0.000; PACTA: 3.5±1.4 segments vs. 4.9±2.0 segments,P=0.009). The New York Heart Association (NYHA) functional class and 6 minute walk distance (6MWD) in the proximal group were significantly better than those in the distal group (1.7±0.5 class vs 2.3±0.4 class; 479.2±51.2 m vs. 438.6±39.5 m, P=0.003). Venous thrombosis in double lower limbs reoccurred in two patients. According to KaplanMeier actuarial curve, the freedom from reembolism at 3 years was 96.7%±2.8%. Bleeding complications occurred in three patients. The linear Bleeding rate related to anticoagulation was 2.47% patientyears. Conclusion Although the early and midlong term survival rate of PTE procedure to treat both proximal and distal types of CTEPH is agreeable, the recovery of the PASP, PVR and 6MWD, and blood gases in patients with proximal type of CTEPH are significantly better than those in patients with distal type of CTEPH. On one hand, anticoagulation can singularly provide enough protection to patients with proximal type of CTEPH, but on the other hand, diuretics and pulmonary hypertension alleviation drug should be added to the treatment regimen for patients with distal type of CTEPH after the procedure of PTE.
Objective To summarize the probability of pulmonary embolism （PE） induced by lower extremity deep venous thrombosis （DVT） and investigate the role of vena cava filter （VCF） in preventing from PE. Methods The clinical data of 1 058 patients with lower extremity DVT from January 2005 to January 2012 were analyzed retrospectively. Results The PE rate was 3.21% （34/1 058） and the death rate was 1.42% （15/1 058） in 1 058 patients with lower extremity DVT. The VCF was implanted in 171 of 1 058 patients. The VCFs of 151 patients were implanted from femoral vein， 20 patients were implanted from jugular vein. The PE rates were 3.61% （32/887） and 1.17% （2/171） and the death rates were 1.69% （15/887） and 0 （0/171） in patients without VCF and with VCF， respectively. Both of them occurred in the first ten days. PE could keep as long as 35 d. The PE rate and death rate in the patients without VCF were significantly higher than those in the patients with VCF （P＜0.01）. The PE rates and death rates in both lower extremities DVT were higher than those in patients with the right and left ones （P＜0.05）， which in the right lower extremity were higher than those in the left one （P＜0.05）. The PE rate and death rate in the patients with lower extremity DVT combined with vena cava thrombosis were significantly higher than those in the patients with central type （P＜0.05）， which in the central type were significantly higher than those in the peripheral type （P＜0.05）， there were no significant differences between peripheral type and mixed pattern. The follow-up time was from 1 month to 7 years with （39±19） months， the patency rate of VCF was 98.7%. There were no filter migration， declination， and failure of expansion. Conclusions VCF can prevent from PE effectively， but the indications must be controlled.
Objective To discuss and evaluate the value of insertion of inferior vena cava filter in treating lower extremity deep venous thrombosis (DVT). Methods Inferior vena cava filters were placed in 46 patients with lower extremity DVT prior treatment, 20 in which were treated by therapy with anticoagulation and thrombolysis, and therapy with pressure gradient, and the other 26 patients by operation and thrombolysis therapy, and therapy with pressure gradient. Whether patients occurred pulmonary embolism was observed and the form and site of filters were monitored by periodic fluoroscopy. Results Inferior vena cava filters were placed successfully in all patients, 38 cases were implanted permanence inferior vena cava filter, 8 cases were implanted temporary inferior vena cava filter. Symptoms and signs of DVT disappeared or remitted in 44/46 patients after treatment. None of pulmonary embolism was occurred. Follow up 2-24 months (average 13 months) for 36 cases with permanence inferior vena cava filter, there was no complication of the filter and pulmonary embolism occurred. Conclusions The method of inserting inferior vena cava filter is simple and safe, which can prevent pulmonary embolism effectually to offer sufficient safeguard for the treatment of DVT.
ObjectivesTo investigate the clinical and imaging characteristics of pleural effusion in patients with acute pulmonary embolism (APE).MethodsComputed tomographic pulmonary angiography (CTPA) scans and clinical data of suspected APE patients from January 2014 to December 2018 were analyzed.ResultsA total of 1024 suspected APE patients underwent CTPA examination in the imaging department of our hospital. Two hundred patients (19.5%) were diagnosed with APE. Imaging findings of pleural effusion were revealed in 70 cases (35.0%). The majority of APE patients without pleural effusion were males (82.3% vs. 64.3%, P<0.01), and the majority of APE patients with pleural effusion were females (35.7% vs. 17.7%, P<0.01). Most of the effusions were bilateral, small to moderate, with peripheral embolism (62.9%, P<0.05). Pulmonary consolidation, atelectasis and ground-glass opacity were common manifestations of CTPA. Compared with patients with simple pulmonary embolism, pulmonary embolism with pleural effusion was more common (62.9% and 33.8%, respectively, OR=3.279 and 95%CI 1.798 - 6.091, P<0.001). Diagnostic thoracic puncture was performed in 6 cases (8.6%). Pleural effusion was exudate in these 6 patients, with normal blood sugar and neutrophils predominated.ConclusionsAbout one third of APE patients are associated with pleural effusion, which most presented with small and bilateral pleural effusions. The main embolism associated with pleural effusion is peripheral embolism. There is a significant correlation between pulmonary consolidation and pleural effusion. Pleural effusion is mostly exudate and neutrophils often predominate.
Objective To improve the knowledge of paradoxical embolism originated from pulmonary embolism. Methods The medical literature about pulmonary embolism complicated with paradoxical embolism from 1998 to 2011 was searched from “Wanfang medical literature database”. Meanwhile 1 case diagnosed in Central Hospital of Dazhou City was reported. Then the clinical characteristics were summarized. Results 51 cases of pulmonary embolism complicated with paradoxical embolism were diagnosed, aged from23 to 76 years old. There were 27 males and 23 females, and sex was unknown in 1 case. In all cases, the cerebral embolism occurred in 30 cases( 58. 8% ) , lower limb artery embolism in 14 cases( 27. 4% ) , kidney artery embolism in 6 cases( 11. 8% ) , patent foramen ovale with straddling thrombus in 4 cases( 8% ) ,multiple embolismin 8 cases( 15. 7% ) , heart ventricle with straddling thrombus in 1 case ( 1. 96% ) , coronary artery embolism in 1 case( 1. 96% ) , aorta embolism in 1 case( 1. 96% ) , and spleen embolism in 1 case ( 1. 96% ) . There were 35 patients ( 68. 8% ) with patent foramen ovale and 7 cases ( 13. 7% ) died. Conclusions Paradoxical embolism waranted more awareness in the cases of pulmonary embolismand/ or venous thromboembolism and aggressive screening might avoid misdiagnosis.
Objective To explore the relationship between thrombocytosis and all-cause in-hospital mortality in patients with chronic obstructive pulmonary disease (COPD) and low-risk pulmonary embolism (PE). Methods In a multicenter retrospective study on clinical characteristics, COPD patients with proven acute PE between October 2005 and February 2017 were enrolled. The patients in risk classes III-V on the basis of the PESI score were excluded. The patients with COPD and low-risk PE were divided into two groups of those with thrombocytosis and without thrombocytosis after extracting platelet count on admission. The clinical characteristics and prognosis of the two groups were compared. Multivariate logistic regression was performed to reveal an association between thrombocytosis and all-cause in-hospital mortality after confounding variables were adjusted. Results A total of 874 consecutive patients with COPD and PE at low risk were enrolled in which 191 (21.9%) with thrombocytosis. Compared with those without thrombocytosis, the thrombocytopenic group had significantly lower body mass index [(20.9±3.3) kg/m2 vs. (25.1±3.8) kg/m2, P=0.01], lower levels of forced expiratory volume in one second (FEV1) [(0.9±0.4) L vs. (1.3±0.3) L, P=0.001] and lower partial pressure of oxygen in the arterial blood (PaO2) [(7.8±1.2) kPa vs. (9.7±2.3) kPa, P=0.003]. The COPD patients with thrombocytosis had a higher proportion of cardiovascular complications as well as higher level of systolic pulmonary arterial pressure (sPAP) [(46.5±20.6) mm Hg vs. (34.1±12.6) mm Hg, P=0.001]. Multivariate logistic regression analysis after adjustment for confounders revealed that thrombocytosis was associated with all-cause mortality in hospitalized patients with COPD and low-risk PE (adjusted OR=1.53, 95%CI 1.03–2.29), and oral antiplatelet treatment was a protective factor (adjusted OR=0.71, 95%CI 0.31–0.84). Conclusions Thrombocytosis is an independent risk factor for all-cause in-hospital mortality in COPD patients with PE at low risk. Antiplatelet therapy may play a protective role in the high-risk cohort.
Objective To assess the overall diagnostic value of magnetic resonance angiography ( MRA) in patients with suspected pulmonary embolism. Methods A search in Cochrane Library,Medline,Embase,Wanfang and China Biology Medicine disc ( CBMdisc) was performed to identify relevant English and Chinese language publications from1990 to 2012. Criteria for inclusion was established based on validity criteria for diagnostic research published by the Cochrane Methods Group on Screening and Diagnostic Tests. Subsequently, the characteristics of the included articles were appraised and extracted. Statistical analysis was performed byMeta-disc version1. 4. Heterogeneity of the included articles was tested, which was used to select proper effect model to calculate pooled weighted sensitivity, specificity, positive likelihood ratio and negative likelihood ratio. Summary receiver opertating characteristic ( SROC) curve was performed and the area under the curve ( AUC) was calculated.Results 6 literatures in English were finally collected, with a total of 534 cases recruited into the study. Heterogeneity was found because of threshold effect. A Metaanalysis was performed using the randomeffect model. The value of the positive likelihood ratio and negative likelihood ratio of MRA with 95% confidence interval ( 95% CI) were 32. 392( 15. 951-65. 778) and 0. 217( 0. 160-0. 294) , respectively. The pooled weighted sensitivity and specificity were 0. 800 ( 0. 728-0. 860)and 0. 984( 0. 966-0. 994) , respectively. The AUC of SROC was 0. 9783. Conclusions MRA has certain diagnosis value for pulmonary embolismwith high sensitivity and specificity. MRA may be the best choice for some patients with renal mysfunction and allergy to radiographic contrast material. Otherwise, patients who are detected by MRA avoid exposure to ionizeing radiation.