本文選題：急性肺栓塞 + CT肺動(dòng)脈栓塞指數(shù)��； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：背景與目的肺動(dòng)脈栓塞是內(nèi)源性或外源性栓子堵塞肺動(dòng)脈或其分支引起的一種臨床綜合征,如何早期識別并及時(shí)處理急性肺栓塞是目前研究的重心,隨著影像學(xué)技術(shù)的發(fā)展,CTPA已經(jīng)成為診斷肺栓塞的主要方法,多項(xiàng)研究已證明CT肺動(dòng)脈栓塞指數(shù)對于預(yù)測急性肺栓塞患者的預(yù)后有重要影響,本文旨在通過分析肺動(dòng)脈栓塞指數(shù)與急性肺栓塞危險(xiǎn)度,以及與實(shí)驗(yàn)室相關(guān)指標(biāo)和影像學(xué)相關(guān)參數(shù)的關(guān)系,探討肺動(dòng)脈栓塞指數(shù)在急性肺栓塞患者危險(xiǎn)度評估中的價(jià)值方法回顧性收集邵逸夫醫(yī)院2013年1月到2017年1月之間首次診斷為急性肺血栓栓塞的患者77例,根據(jù)2014ESC指南中的危險(xiǎn)度分類,將這部分人群分成低危組(A組)、中低危組(B組)、中高危和高危組(C組),根據(jù)患者的CTPA表現(xiàn),分別計(jì)算每組患者的Qanadli及Mastora肺動(dòng)脈栓塞指數(shù),比較不同組間CT肺動(dòng)脈栓塞指數(shù)的差異,并比較相關(guān)參數(shù)與CT肺動(dòng)脈栓塞指數(shù)的相關(guān)性。結(jié)果1.C組患者的暈厥比例明顯高于其他兩組。2.肺栓塞患者的動(dòng)脈血?dú)庵?PaC02及氧合指數(shù)均隨著肺栓塞危險(xiǎn)度上升呈逐漸下降趨勢。NT-proBNP、cTn Ⅰ在中高及高�；颊咧忻黠@升高。3.RVSP、MPA/AA、RV/LV隨著肺栓塞危險(xiǎn)度增加,呈逐漸升高趨勢,其中RVSP、MPA/AA在A、B、C三組中均存在統(tǒng)計(jì)學(xué)差異,RV/LV在A組與B組及C組比較時(shí)有統(tǒng)計(jì)學(xué)差異,而在B組與C組比較時(shí)無明顯統(tǒng)計(jì)學(xué)差異。4.Qanadli及Mastora肺動(dòng)脈栓塞指數(shù)均隨著肺栓塞危險(xiǎn)度升高而呈上升趨勢,三組間比較均存在統(tǒng)計(jì)學(xué)差異。Qanadli及Mastora栓塞指數(shù)與脈搏、DDI、NT-proBNP、cTnI、RV/LV之間存在正相關(guān),相關(guān)系數(shù)范圍分別為0.318～0.526;0.231～0.570。與PaC02、氧合指數(shù)、LVEF呈負(fù)相關(guān),相關(guān)系數(shù)范圍分別為-0.310～-0.368;-0.318～-0.345。其中,Qanadli及Mastora栓塞指數(shù)均與cTnI相關(guān)性最大,相關(guān)系數(shù)分別為0.526、0.570。5.將患者分成中高危+高危組、低危+中低危組,對Qanadli及Mastora栓塞指數(shù)行ROC曲線得出,Qanadli及Mastora栓塞指數(shù)對于區(qū)別兩組具有較高的靈敏度和特異度。結(jié)論1.Qanadli及Mastora栓塞指數(shù)均與急性肺栓塞患者的危險(xiǎn)度呈相關(guān)性,Qanadli及Mastora栓塞指數(shù)與臨床多項(xiàng)參數(shù)存在相關(guān)性2.Qanadli栓塞指數(shù)截?cái)嘀?4%或Mastora栓塞指數(shù)截?cái)嘀?7%,對于區(qū)別高危組+中高危組及低危組+中低危組具有較高的靈敏度和特異度。3.CT肺動(dòng)脈栓塞指數(shù)對于早期評估肺栓塞的危險(xiǎn)度,指導(dǎo)進(jìn)一步治療方面存在重要的臨床意義。
[Abstract]:Background & objective Pulmonary embolism is a kind of clinical syndrome caused by endogenous or exogenous embolus blocking pulmonary artery or its branches. How to identify and deal with acute pulmonary embolism early and timely is the focus of current research. With the development of imaging techniques, CTPA has become the main method for the diagnosis of pulmonary embolism. Several studies have proved that CT pulmonary embolism index plays an important role in predicting the prognosis of patients with acute pulmonary embolism. The aim of this study was to analyze the relationship between pulmonary embolism index and acute pulmonary embolism risk, laboratory and imaging parameters. To explore the value of pulmonary embolism index in risk assessment of patients with acute pulmonary embolism methods A retrospective study was made on 77 patients with acute pulmonary thromboembolism diagnosed for the first time between January 2013 and January 2017 in Shaw Hospital. According to the classification of risk in 2014ESC guidelines, this group was divided into three groups: group A in low risk group, group B in low risk group, group C in middle high risk group and high risk group. According to the CTPA manifestation of patients, the Qanadli and Mastora pulmonary embolism index of each group were calculated respectively. To compare the difference of CT pulmonary embolism index between different groups, and to compare the correlation between relevant parameters and CT pulmonary embolism index. Results 1. The rate of syncope in group C was significantly higher than that in the other two groups. 2. PaC02 and oxygenation index in arterial blood gas of pulmonary embolism patients showed a decreasing trend with the increase of pulmonary embolism risk. NT-proBNPcTn 鈪，

本文編號：1922126