• 昆明醫(yī)學(xué)院第二附屬醫(yī)院呼吸內(nèi)科( 云南昆明 650101);

COPD 在世界范圍均是主要的健康負(fù)擔(dān), 到2020 年,COPD 將可能成為第三大的死亡原因。而大部分COPD 死亡發(fā)生在它的急性發(fā)作期。以前的研究表明50% ～70% 的
COPD 急性加重( AECOPD) 是由于感染造成, 10% 歸于環(huán)境因素, 超過(guò)30% 的患者發(fā)作原因并不清楚[ 1] 。其主要發(fā)作的癥狀是咳嗽和呼吸困難, 而肺栓塞( PE) 的癥狀很難從中
區(qū)分。有報(bào)道認(rèn)為COPD 發(fā)生PE 和其他靜脈血栓形成的概率是非COPD 患者的2 倍, 同時(shí)也認(rèn)為COPD 是發(fā)生PE 的主要危險(xiǎn)因素, PE 可能是COPD 急性發(fā)作常見(jiàn)原因[ 2] 。而
目前的COPD 診治指南并未明確PE 是COPD 急性發(fā)作的可能原因之一, 只是在治療中提出對(duì)臥床、紅細(xì)胞增多癥或脫水的患者, 無(wú)論是否有血栓栓塞性疾病史均需考慮使用肝素
或低分子肝素。這種觀點(diǎn)可能是從PE 的危險(xiǎn)評(píng)估角度來(lái)看, 但也可能造成臨床使用時(shí)抗凝劑量的不充分, 導(dǎo)致COPD 患者死亡。那么PE 在AECOPD 中的地位究竟如何?現(xiàn)就相關(guān)研究文獻(xiàn)綜述如下。

引用本文： 董昭興,張濤,李永霞. 肺栓塞在COPD 急性加重期中的作用. 中國(guó)呼吸與危重監(jiān)護(hù)雜志, 2010, 9(6): 652-653. doi: 復(fù)制

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1. Sapey E, Stockley RA. COPD exacerbations: 2. Aetiology. Thorax,2006, 61: 250-258 .
2. Sidney S, Sorel M, Quesenberry CP Jr, et al. COPD and incident cardiovascular disease hospitalizations and mortality: Kaiser Permanente Medical Care Program. Chest, 2005 , 128: 2068-2075.
3. Carson JL, Terrin ML, Duff A, et al. Pulmonary embolism and mortality in patients with COPD. Chest, 1996, 110: 1212-1219.
4. Tillie-Leblond I,Marquette CH, Perez T, et al. Pulmonary embolism in patients with unexplained exacerbation of chronic obstructive pulmonary disease: prevalence and risk factors. Ann Intern Med,2006, 144: 390-396.
5. Erelel M, Cuhadaroglu C, Ece T, et al. The frequency of deep venous thrombosis and pulmonary embolus in acute exacerbation of chronic obstructive pulmonary disease. Respir Med, 2002 , 96: 515 -518.
6. Shetty R, Seddighzadeh A, Piazza G, et al. Chronic obstructive pulmonary disease and deep vein thrombosis: a prevalent combination. J Thromb Thrombolysis, 2008, 26 : 35-40.
7. Rutschmann OT, Cornuz J, Poletti PA, et al. Should pulmonary embolism be suspected in exacerbation of chronic obstructive pulmonary disease? Thorax, 2007, 62 : 121-125 .
8. Rizkallah J, Man SF, Sin DD. Prevalence of pulmonary embolism in acute exacerbations of COPD: a systematic review and meta analysis. Chest, 2009, 135: 786 -793.
9. Lippmann M, Fein A. Pulmonary embolism in the patient with chronic obstructive pulmonary disease. A diagnostic dilemma.Chest, 1981, 79: 39-42.
10. Wagner PD, Dantzker DR, Dueck R, et al. Ventilationperfusion inequality in chronic obstructive pulmonary disease. J Clin Invest,1977, 59: 203-216 .
11. Hartmann IJ, Hagen PJ, Melissant CF, et al. Diagnosing acute pulmonary embolism: effect of chronic obstructive pulmonary disease on the performance of D-dimer testing, ventilation/ perfusion scintigraphy, spiral computed tomographic angiography, and conventional angiography. ANTELOPE Study Group. Advances in New Technologies Evaluating the Localization of Pulmonary Embolism. Am J Respir Crit Care Med, 2000, 162 : 2232-2237.
12. Ambrosetti M, Ageno W, Spanevello A, et al. Prevalence and prevention of venous thromboembolism in patients with acute exacerbations of COPD. Thromb Res, 2003 , 112: 203-207.
13. Fraisse F, Holzapfel L, Couland JM, et al. Nadroparin in the prevention of deep vein thrombosis in acute decompensated COPD.The association of non-university affiliated intensive care specialist physicians of france. Am J Respir Crit Care Med, 2000, 161: 1109 -1114.
14. Kahn SR, Panju A, GeertsW, et al. Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada. Thromb Res, 2007, 119 : 145-155.
15. Alikhan R, Cohen AT. A safety analysis of thromboprophylaxis in acute medical illness. Thromb Haemost, 2003 , 89: 590-591.
16. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: american college of chest physicians evidencebased clinical practice guidelines ( 8th Edition) . Chest, 2008, 133 :381S-453S.
  1. 1. Sapey E, Stockley RA. COPD exacerbations: 2. Aetiology. Thorax,2006, 61: 250-258 .
  2. 2. Sidney S, Sorel M, Quesenberry CP Jr, et al. COPD and incident cardiovascular disease hospitalizations and mortality: Kaiser Permanente Medical Care Program. Chest, 2005 , 128: 2068-2075.
  3. 3. Carson JL, Terrin ML, Duff A, et al. Pulmonary embolism and mortality in patients with COPD. Chest, 1996, 110: 1212-1219.
  4. 4. Tillie-Leblond I,Marquette CH, Perez T, et al. Pulmonary embolism in patients with unexplained exacerbation of chronic obstructive pulmonary disease: prevalence and risk factors. Ann Intern Med,2006, 144: 390-396.
  5. 5. Erelel M, Cuhadaroglu C, Ece T, et al. The frequency of deep venous thrombosis and pulmonary embolus in acute exacerbation of chronic obstructive pulmonary disease. Respir Med, 2002 , 96: 515 -518.
  6. 6. Shetty R, Seddighzadeh A, Piazza G, et al. Chronic obstructive pulmonary disease and deep vein thrombosis: a prevalent combination. J Thromb Thrombolysis, 2008, 26 : 35-40.
  7. 7. Rutschmann OT, Cornuz J, Poletti PA, et al. Should pulmonary embolism be suspected in exacerbation of chronic obstructive pulmonary disease? Thorax, 2007, 62 : 121-125 .
  8. 8. Rizkallah J, Man SF, Sin DD. Prevalence of pulmonary embolism in acute exacerbations of COPD: a systematic review and meta analysis. Chest, 2009, 135: 786 -793.
  9. 9. Lippmann M, Fein A. Pulmonary embolism in the patient with chronic obstructive pulmonary disease. A diagnostic dilemma.Chest, 1981, 79: 39-42.
  10. 10. Wagner PD, Dantzker DR, Dueck R, et al. Ventilationperfusion inequality in chronic obstructive pulmonary disease. J Clin Invest,1977, 59: 203-216 .
  11. 11. Hartmann IJ, Hagen PJ, Melissant CF, et al. Diagnosing acute pulmonary embolism: effect of chronic obstructive pulmonary disease on the performance of D-dimer testing, ventilation/ perfusion scintigraphy, spiral computed tomographic angiography, and conventional angiography. ANTELOPE Study Group. Advances in New Technologies Evaluating the Localization of Pulmonary Embolism. Am J Respir Crit Care Med, 2000, 162 : 2232-2237.
  12. 12. Ambrosetti M, Ageno W, Spanevello A, et al. Prevalence and prevention of venous thromboembolism in patients with acute exacerbations of COPD. Thromb Res, 2003 , 112: 203-207.
  13. 13. Fraisse F, Holzapfel L, Couland JM, et al. Nadroparin in the prevention of deep vein thrombosis in acute decompensated COPD.The association of non-university affiliated intensive care specialist physicians of france. Am J Respir Crit Care Med, 2000, 161: 1109 -1114.
  14. 14. Kahn SR, Panju A, GeertsW, et al. Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada. Thromb Res, 2007, 119 : 145-155.
  15. 15. Alikhan R, Cohen AT. A safety analysis of thromboprophylaxis in acute medical illness. Thromb Haemost, 2003 , 89: 590-591.
  16. 16. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: american college of chest physicians evidencebased clinical practice guidelines ( 8th Edition) . Chest, 2008, 133 :381S-453S.