ObjectiveTo investigate the anticoagulant drug treatment decision for patients with renal contusion and acute pulmonary embolism, and to enhance the level of treatment for this disease. MethodsA retrospective analysis of the clinical data of a patient with renal contusion and acute pulmonary embolism treated at the West China Hospital of Sichuan University, along with a relevant literature review. Databases including PubMed, Ovid Medline, Embase, VIP, Wanfang and Chinese National Knowledge infrastructure were searched using the keywords as “Pulmonary embolism” AND “Hemorrhage”from January 1983 to December 2023. ResultThe patient was a 21-year-old male who presented with right kidney contusion for 5 days and dyspnea for 1 day. The abdominal CT scan revealed a ruptured right kidney accompanied by hemorrhage and hematoma in the surrounding tissue. Abdomen ultrasound: a low echogenic area measuring approximately 10.6 cm×2.8 cm is noted around the right kidney. The CT pulmonary angiography (CTPA) demonstrated filling defects at the bifurcation of the pulmonary trunk, as well as within the upper and lower lobes of both lungs and their respective branches. The blood gas analysis of patient indicated (face mask oxygen therapy at 10 L/min, oxygenation index of 120): pH 7.456, PCO2 24.9 mm Hg, PO2 73.2 mm Hg. His myocardial markers were Myoglobin: 79.21 ng/ml, Troponin T: 58.7 ng/L, BNP: 2062 ng/L. The patient was diagnosed with renal contusion and pulmonary embolism, and was treated with subcutaneous heparin（initial dose is given as an 80 IU/kg intravenous bolus, followed by a continuous infusion of 12-18 IU/kg/h） and low-molecular-weight heparin at a dose of 0.8 ml every 12 hours one after another for anticoagulation, along with symptomatic treatment. Following the intervention, the patient's respiratory distress showed significant improvement, and subsequent arterial blood gas analysis indicated enhanced oxygenation. Then, the anticoagulant medication was adjusted to oral rivaroxaban anticoagulation for 6 months, follow-up CTPA scan revealed complete resolution of the pulmonary embolism and the abdominal CT scan indicated a reduction in the extent of patchy low-density shadows surrounding the right kidney, leading to the discontinuation of anticoagulation therapy. After searching the above-mentioned databases, total of 26 articles were identified that reported on 30 patients diagnosed with high-risk bleeding and acute pulmonary embolism; among these, 3 patients succumbed while 27 exhibited clinical improvement. ConclusionsPatients with renal contusion and acute pulmonary embolism can be safely and effectively treated with low-dose heparin anticoagulation under close monitoring. High-risk bleeding patients with acute pulmonary embolism present a significant challenge in clinical practice. After weighing the risks of bleeding disorders and the adverse outcomes of pulmonary embolism, it is necessary to find the optimal balance between anticoagulation and bleeding. Consequently, the formulation of personalized treatment strategies in accordance with established guidelines can enhance patient outcomes.
Objective To investigate the smoking status and factors influencing tobacco dependence among inpatients with respiratory diseases, and analyze the relationship of salivary and plasma nicotine metabolic ratio (NMR) with tobacco dependence and withdrawal symptoms. Methods A cross-sectional study was conducted on eligible patients admitted to the Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, between October 2023 and October 2024. Basic information of enrolled patients was collected and smoking questionnaires were administered. The participants were categorized into current smokers or former smokers based on smoking status. The current smokers were classified into no dependence, mild dependence, moderate dependence, and severe dependence by ICD-10, Chinese guidelines, and FTND. Group differences were analyzed with ANOVA and chi-square test. Tobacco dependence risk factors were identified by univariate/multivariate logistic regression. The smokers were stratified into slow and normal metabolizers based on NMR to analyze its correlation with tobacco dependence and withdrawal symptoms. Results Among 602 enrolled patients, 20.4% initiated smoking before age 18 years, with a mean smoking history of 46.2 pack-years. Family members smoked in 49.3% and friends smoked in 89.5% of cases; primary smoking motivations were conformity, curiosity, and boredom relief. Tobacco dependents had significantly higher rates of family member smoking (P=0.005) and withdrawal symptoms (P<0.001). Logistic regression identified lower education level, absence of pulmonary infection, parental smoking, and higher daily cigarette consumption as significant risk factors for tobacco dependence. NMR was positively correlated with nicotine dependence severity (saliva: rs=0.303, P=0.013; plasma: rs=0.297, P=0.045). Normal metabolizers had a significantly higher prevalence of nicotine dependence than slow metabolizers (saliva: 56.3% vs. 33.3%, P=0.014; plasma: 58.8% vs. 25.0%, P=0.044). Withdrawal symptoms were positively correlated with NMR (rs=0.244, P=0.048), with a higher incidence in normal metabolizers (81.3% vs. 58.8%, P=0.048). Conclusions Lower education level, absence of pulmonary infection, parental smoking, and higher daily cigarette consumption are major risk factors for tobacco dependence. Normal nicotine metabolizers are more likely to exhibit higher levels of tobacco dependence and withdrawal symptoms than slow metabolizers.