Objective To explore the clinical manifestations, computed tomography features, management and prognosis of Klebsiella pneumoniae liver abscess complicated with septic pulmonary embolism. Methods The clinical data of patients with Klebsiella pneumoniae liver abscess complicated with septic pulmonary embolism admitted to Dongnan Hospital of Xiamen University from January 2012 to January 2017 were retrospectively analyzed. Results There were 8 patients who had Klebsiella pneumoniae liver abscess complicated with septic pulmonary embolism. Fever occurred in all patients, respiratory symptoms were noted in 5 patients, abdominal pain occurred in 2 patients, endophthalmitis coexisted in 1 patient, and diabetes mellitus coexisted in 7 patients, with no chest pain or hemoptysis. In biochemical indexes, procalcitonin increased most obviously. Microbiological studies revealed Klebsiella pneumoniae in 8 patients. Chest CT showed peripheral nodules with or without cavities, peripheral wedge-shaped opacities, a feeding vessel sign, pleural effusion, and infiltrative shadow. One patient finally deteriorated to acute respiratory failure, and died due to acute respiratory distress syndrome and/or septic shock. There was one case of spontaneous discharge. A total of 6 patients were improved and cured. Conclusions The clinical manifestation of Klebsiella pneumoniae liver abscess complicated with septic pulmonary embolism is unspecific and misdiagnosis rate is relatively high. The major characteristics of chest CT scan include peripheral nodules with or without cavities, peripheral wedge-shaped opacities and a feeding vessel sign. Diagnosis and differential diagnosis can be made based on these features combined with clinical data and primary disease (liver abscess).
为了解我国南方地区肺栓塞的现状,通过检索中国医院数字图书馆近9年(1999年～2008年)南方地区正式发表的与肺栓塞和深静脉血栓有关的论文共1288篇,进行了统计分析,发现:1、中国南方地区肺栓塞的发现数量逐年增加,且增幅明显;2、诊断水准达到一定程度的部分南方医院,诊断治疗肺栓塞的数量明显高于其他医院,并不比中国北方同类医院低;3、肺栓塞的漏诊、误诊现象依然普遍存在,提高认知和诊治水准仍然是今后工作的方向。
Objective To investigate the value of fibrinogen to albumin ratio (FAR) combined with pulmonary embolism severity index (PESI) in the assessment of severity and prognosis of patients with acute pulmonary thromboembolism (APTE). Methods A retrospective study of hospitalized patients with confirmed APTE admitted to the Affiliated Hospital of Southwest Medical University from September 2013 to August 2021, divided into low-risk, intermediate-risk, and high-risk groups according to the Guidelines for the Diagnosis, Treatment and Prevention of Pulmonary Thromboembolism, and divided into survival groups and death groups according to the 30-day prognosis. The general data of all patients and relevant blood laboratory tests within 2 hours after admission were collected to calculate PESI and FAR. FAR and PESI levels were compared in APTE patients with different severity of disease and different prognosis. Independent risk factors for 30-day mortality in APTE patients were analyzed using logistic regression. Subject working characteristic curves were drawn to assess the differences in sensitivity, specificity and area under the curve of FAR, PESI and FAR combined with PESI in predicting 30-day death. Results Total of 235 APTE patients were included, divided into 85 in the low-risk group, 110 in the intermediate-risk group, and 40 in the high-risk group; 192 in the survival group and 43 in the death group according to 30-day survival. The differences in age, albumin (ALB), high-sensitivity troponin, D-dimer, fibrinogen (FIB), FAR, and PESI of APTE patients with different disease severity were statistically significant (P<0.05). FAR increased progressively with increasing severity of disease (P<0.05), and correlation analysis showed a positive correlation between FAR and PESI (r=0.614, P<0.05). Elevated FIB, FAR, PESI and decreased ALB were independent risk factors for 30-day death in patients with APTE (P<0.05). FAR, PESI, and FAR combined with PESI all had predictive value for 30-day death in APTE patients, and FAR combined with PESI predicted the largest area under the 30-day death curve. Conclusions FAR correlated with the severity and prognosis of APTE patients. FAR combined with PESI was more valuable in assessing the 30-day prognosis of APTE patients than FAR alone or PESI alone.
ObjectiveTo explore the diagnostic value of the bedside echocardiogram for different risk stratification of patients with suspected pulmonary embolism. MethodsPatients with suspected pulmonary embolism in the emergency department of the Second Afflicted Hospital Xi'an Jiaotong University between July 2013 to December 2015 were included. According the Wells scores, they were divided into a low risk group (0-2 points), a intermediate risk group (3-6 points) and a high risk group (>6 points). All patients were underwent the bedside echocardiogram diagnosis, and the diagnostic value of the echocardiography for pulmonary embolism, the characteristics of different risk stratification of patients were analyzed by SPSS 18.0 software. Results115 patients with suspected pulmonary embolism were included, of which 20 were in the low risk group, 73 were in the medium risk group, and 22 were in the high risk group. The incidence of pulmonary embolism among the three groups was significantly different (high-risk vs. medium risk vs. low-risk: 90.9% vs. 76.7% vs. 15.0%, P<0.05), and the higher Wells scores gets, the greater possibility of having the pulmonary embolism. For the intermediate-risk group, the incidence of pulmonary embolism was significantly higher in patients with positive ultrasonic results than those with the negative ultrasonic results (87.3% vs. 44.4%, P<0.05). The predication of the ultrasonic positive and the negative in the low and high risk groups had no statistical differences (P>0.05). The result of echocardiogram showed that the right ventricular end-diastolic diameter, right ventricular end-diastolic transverse diameter, right atrial end-diastolic transverse diameter, RV/LV, RA/LA in the high risk group and the intermediate risk group were significantly higher than those in the low risk group (all P values <0.05). The right ventricular anterior wall activity in the low risk group was higher than that in the high risk group (P<0.05), but this difference was not found between the high risk group and the intermediate risk group. ConclusionBedside echocardiogram can be used as the diagnosis and differential diagnosis methods of suspected pulmonary embolism, and it has relatively higher diagnostic value for intermediate to high risk patients predicted by the Wells scores than low risk ones.
To assess the efficacy and safety of thrombolytic therapy. Electronic search was applied to the Cochrane Airways Group register (MEDLINE, EMBASE, CINAHL standardized searches) with the date up to 2003 April. Hand searched respiratory journals and meeting abstracts. All randomized controlled trials comparing thrombolytic therapy with heparin alone or surgical intervention (eg. embolectomy) met the inclusion criteria. Two reviewers independently selected trials, assessed trial quality and extracted the data.
Objective To explore and compare the diagnostic value of blood pressure, brain natriuretic peptide (BNP), pulmonary artery systolic pressure (PASP) in evaluating right ventricular dysfunction (RVD) in patients with acute pulmonary embolism (APE). Methods A retrospective study was conducted on 84 APE patients who were diagnosed by computed tomographic pulmonary angiography. The patients were divided into a RVD group and a non-RVD group by echocardiography. Eighteen clinical and auxiliary examination variables were used as the research factors and RVD as the related factor. The relationship between these research factors and RVD were evaluated by logistic regression model, the diagnostic value of BNP and PASP to predict RVD was analyzed by receiver-operating characteristic (ROC) curve analysis. Results The patients with RVD had more rapid heart rate, higher diastolic blood pressure, higher mean arterial pressure, higher incidence of BNP>100 pg/ml and higher incidence of PASP>40 mm Hg (allP<0 05="" upon="" logistic="" regression="" model="" bnp="">100 pg/ml (OR=4.904, 95%CI 1.431–16.806, P=0.011) and PASP>40 mm Hg (OR=6.415, 95%CI 1.509–27.261, P=0.012) were independent predictors of RVD. The areas under the ROC curve to predict RVD were 0.823 (95%CI 0.729–0.917) for BNP, and 0.798 (95%CI 0.700–0.896) for PASP. Conclusions Blood pressure related parameters can not serve as a predictor of RVD. Combined monitoring of BNP level and PASP is helpful for accurate prediction of RVD in patients with APE.
ObjectivesTo evaluate the effects of Pulmonary Embolism Response Team (PERT) on treatment strategies and long-term prognosis in patients with acute pulmonary embolism before and after the implementation of the first PERT in China. Methods The official start of PERT (July 2017) was took as the cut-off point, all APE patients who attended Beijing Anzhen Hospital of Capital Medical University one year before and after this cut-off time were included through the hospital electronic medical record system. The APE patients who received traditional treatment from July 5, 2016 to July 4, 2017 were recruited in the control group (Pre-PERT group), and the APE patients who received PERT mode treatment from July 5, 2017 to July 4, 2018 were recruited as the intervention group (Post-PERT group). Treatment methods during hospitalization were compared between the two groups. The patients were followed up for one year after discharge to evaluate their anticoagulant therapy, follow-up compliance and long-term prognosis. Results A total of 108 cases in the Pre-PERT group and 102 cases in the Post-PERT group were included. There was no significant statistical difference between the two groups in age and gender (both P>0.05). Anticoagulation therapy (87.3% vs. 81.5%, P=0.251), catheter-directed treatment (3.9% vs. 2.8%, P=0.644), inferior vena cava filters (1.0% vs. 1.9%, P=1.000), surgical embolectomy (2.0% vs. 0.9%, P=0.613), systemic thrombolysis (3.9% vs. 4.6%, P=0.582) were performed in both groups with no significant differences between the two groups. The use rate of rivaroxaban in the Post-PERT group was higher than that in the Pre-PERT group at one year of discharge, and the use rate of warfarin was lower than that of the Pre-PERT group (54.5% vs. 32.5%; 43.6% vs. 59.0%, P=0.043). The anticoagulation time of the Post-PERT group was longer than that of the Pre-PERT group (11.9 months vs. 10.3 months, P<0.001). The all-cause mortality within one year, hemorrhagic events and the rate of rehospitalization due to pulmonary embolism were not significantly different between the two groups, (10.4% vs. 8.6%), (14.3% vs. 14.8%), and (1.3% vs. 2.5%, χ2=3.453, P=0.485), respectively. Conclusions APE treatment was still dominated by anticoagulation and conventional treatment at the early stage of PERT implementation, and advanced treatment (catheter-directed treatment and surgical embolectomy) is improved, it showed an expanding trend after only one year of implementation although there was no statistical difference. At follow-up, there is no increase in one-year all-cause mortality and bleeding events with a slight increase in advanced treatment after PERT implementation.