發(fā)布時間：2018-05-02 15:00

  本文選題：急性肺栓塞 + 介入治療��； 參考：《昆明醫(yī)科大學》2013年碩士論文

【摘要】：目的：通過回顧分析急性肺動脈血栓栓塞的DSCT表現(xiàn)及不同方法治療后的影像學改變,探討DSCT對急性肺動脈血栓栓塞的診斷及治療后隨訪的價值,同時對照分析各種治療方法的有效率,加強對急性肺動脈血栓栓塞診斷及治療的認識,提高早期診斷率及治療療效,減少漏診、誤診和死亡率。材料和方法：回顧性分析本院收治的47例急性肺動脈血栓栓塞病例。全部患者治療前均作了DSCTPA檢查,并在治療后7天至2個月內(nèi)作過2次以上復查；其中20例行溶栓治療,18例行單純抗凝治療,9例進行了介入治療。一、分析DSCT表現(xiàn)：(1)肺動脈栓塞部位及栓子形態(tài)；(2)栓塞動脈管徑測量；(3)不同后處理技術(shù)對各級肺動脈病灶的檢出率。二、依據(jù)臨床癥狀改善及影像學變化,綜合分析不同治療方案的療效對比：療效評價劃分為無效(包括無變化、惡化和死亡)、有效和顯效。(1)無效：臨床癥狀無明顯緩解,治療后復查CT提示栓子無變化。惡化(含死亡)：臨床癥狀較前加重,治療后復查CT提示栓子較前增大、增多。(2)有效：臨床癥狀明顯減輕,治療后復查CT提示栓子減少、縮小≥1/2；(3)顯效：臨床癥狀減輕,治療后復查CT提示栓子縮小、減小≥1/4。數(shù)據(jù)采用excel錄入數(shù)據(jù),利用SPSS17.0統(tǒng)計軟件包進行相關(guān)數(shù)據(jù)分析,行卡方檢驗,秩和檢驗。 結(jié)果：一、影像學表現(xiàn)：(1)右肺動脈累及281處,左肺動脈累及101處,雙肺下葉動脈累及256處,雙肺中上葉動脈累及94處,右肺動脈栓塞較左肺動脈常見,雙下葉肺動脈栓塞較中上肺常見；栓子形態(tài)呈馬鞍征、漂浮征、環(huán)征、軌道征表現(xiàn)為血栓游離于肺動脈管腔內(nèi),提示新鮮血栓(34/47,75.56%)。(2)多數(shù)栓塞動脈血管管徑增寬(293/385,76.10%),血管管徑無變化23.90%；(3)在1級肺動脈血管肺栓塞檢出率MPR、MIP、VR三種處理方式無任何差別；在2—3級肺動脈血管MPR檢出率高于MIP和VR,但結(jié)果不具有統(tǒng)計學意義(P=0.13)；在4—5級肺動脈血管MPR檢出率較高,與MIP和VR差異顯著(P0.001)；二、療效對比：溶栓組、單純抗凝組顯效率高于介入組,差異有顯著性(P0.001)；介入組有效率高于溶栓組及抗凝組,差異具有顯著性(P0.001)；總有效率介入組、單純抗凝組、溶栓組三組間比較無差異。 結(jié)論：一、影像學表現(xiàn) 1.急性肺動脈血栓栓塞右肺發(fā)病率高于左肺,雙下肺高于雙上肺；栓子形態(tài)呈馬鞍征、漂浮征、環(huán)征、軌道征提示為新鮮血栓。 2.多數(shù)急性栓塞血管管徑增寬。 3.在1級肺動脈血管栓塞檢出率MPR、MIP、VR三種后處理方式無任何差別；在2—3級肺動脈血管MPR檢出率高于MIP和VR；在4—5級肺動脈血管MPR檢出率顯著高于MIP和VR。 二、療效評估 單純抗凝、溶栓及介入治療均是急性PTE治療的有效方法,急性大面積肺栓塞介入治療的有效率高于前兩者,但具有一定的風險性。 三、DSCT是診斷急性肺動脈血栓栓塞和治療后隨訪的首選影像學檢查方法。
[Abstract]:Objective: to investigate the value of DSCT in the diagnosis and follow-up of acute pulmonary thromboembolism (APE) by retrospectively analyzing the DSCT manifestations of acute pulmonary thromboembolism (APE) and the imaging changes after different treatments. At the same time, the effective rate of various treatment methods was compared and analyzed to strengthen the understanding of diagnosis and treatment of acute pulmonary thromboembolism, to improve the early diagnosis rate and therapeutic effect, to reduce missed diagnosis, misdiagnosis and mortality. Materials and methods: 47 cases of acute pulmonary thromboembolism were retrospectively analyzed. All the patients were examined by DSCTPA before treatment, and 2 or more reexaminations were made within 7 days to 2 months after treatment, of which 20 cases were treated with thrombolytic therapy and 18 cases were treated with anticoagulant therapy alone, 9 cases were treated with interventional therapy. The main results of this study were as follows: (1) DSCT findings: (1) the location of pulmonary embolism and the shape of embolism (2) the diameter of embolism artery were measured. (3) the detectable rate of pulmonary artery lesions at all levels was detected by different post-processing techniques. Secondly, according to the improvement of clinical symptoms and imaging changes, comprehensive analysis of the efficacy comparison of different treatment plans: the evaluation of efficacy was divided into invalid (including no change, deterioration and death, effective and effective. 1) no significant relief of clinical symptoms. Ct examination showed no change in embolus after treatment. Deterioration (including death: clinical symptoms were more severe, CT examination after treatment showed that embolus was larger than before, increase. 2) effective: clinical symptoms were obviously alleviated, after treatment CT showed that embolus decreased, narrowing 鈮，

本文編號：1834389