【摘要】：[目的]分析急性肺栓塞(acute pulmonary embolism, APE)患者的CT肺血管成像(CTpulmonary angiography, CTPA)檢查、超聲心動圖(ultrasound cardiogram, UCG)檢查及血氣分析,探討APE患者的CT肺動脈栓塞指數(shù)(pulmonary artery obstruction index, PAOI)對右心功能的評價。 [方法]收集2011年12月至2012年12月期間,昆明醫(yī)科大學第二附屬醫(yī)院呼吸內科,己行電子計算機X射線斷層掃描技術(computed tomography, CT)檢查、血氣分析檢驗、超聲心動圖檢查的,經(jīng)CTPA確診為PE、無嚴重基礎心肺疾病、且無活動性出血、近期內未接受抗凝治療,無明確的慢性血栓栓塞性疾病史的APE患者54例。 分析已確診為APE的54例患者的CTPA和UCG、血氣分析。使用Qanadli等設計的評分方法計算CT阻塞指數(shù),同時經(jīng)CT測量右心功能參數(shù),主要為心臟徑線和血管徑線的測量。其中心臟經(jīng)線包括右室短軸最大直徑(right ventricular short axis diameter, RVd)、左室短軸最大直徑(left ventricular short axis diameter, LVd)、右室與左室短軸最大直徑比(RVd/LVd);血管徑線包括主肺動脈直徑(main pulmonary artery diameter, MPA)、上腔靜脈直徑(superior vena cava diameter, SVC)。根據(jù)54例APE患者的CT肺動脈栓塞指數(shù)(PAOI),按PA0I30%、30%≤PA0I50%和PAOI"g50%,將APE患者分為輕、中和重度三組。分別分析各組經(jīng)CT測量所得右心功能參數(shù)否存在差異,分析經(jīng)UCG測得右心功能參數(shù)是否存在差異,分析各組間血氣分析中動脈血氧分壓(arterial partial pressure of oxygen, PaO2)及動脈血二氧化碳分壓(arterial partial pressure of carbon dioxide, PaC02)間的差異,同時分析經(jīng)CT測得右心功能參數(shù)與UCG測得參數(shù)是否存在相關性。 [結果]根據(jù)CT肺栓塞指數(shù)將54例患者分為輕(36例)、中(13例)、重(5例)三組。 1.三組間經(jīng)CT測得右心功能參數(shù)計量資料的比較 輕度、中度和重度三組CT測得右心功能參數(shù)(RVd、LVd、RVd/LVd、SVC、MPA)進行比較,差異有統(tǒng)計學意義(P0.05),LVd呈逐漸減小趨勢,RVd、RVd/LVd、SVC,MPA呈逐漸增大趨勢。 2.三組間經(jīng)UCG測得右心功能參數(shù)計量資料的比較 輕度、中度和重度三組UCG測得右心功能參數(shù)(RVd、LVd、RVd/LVd)進行比較,差異有統(tǒng)計學意義(P0.05),LVd呈逐漸減小趨勢,RVd、RVd/LVa呈逐漸增大趨勢。 3.三組間血氣分析Pa02及PaCO2計量資料的比較 輕度、中度和重度三組血氣分析(PaO2、PaCO2)進行比較,PaO2、PaCO2差異有統(tǒng)計學意義(P0.05),呈逐漸減小趨勢。 4.經(jīng)CT測得右心功能參數(shù)與經(jīng)UCG測得右心功能參數(shù)相關性比較 經(jīng)CT測得右心功能參數(shù)(RVd、LVd、RVd/LVd)與經(jīng)UCG測得右心功能參數(shù)(RVd、LVd、RVd/LVd)呈正相關。 [結論]通過本研究得出,CT肺栓塞指數(shù)對急性肺栓塞患者右心功能的評價具有一定的價值,有助于判定APE患者右心功能的嚴重程度及分級,從而指導臨床合理治療及評估預后。
[Abstract]:[objective] to investigate the evaluation of right ventricular function by CT pulmonary embolism index (pulmonary artery obstruction index, PAOI) in patients with acute pulmonary embolism (acute pulmonary embolism, APE) by analyzing CT pulmonary angiography (CTpulmonary angiography, CTPA), echocardiography (Echocardiography) (ultrasound cardiogram, UCG) and blood gas analysis (BGE) in patients with acute pulmonary embolism (acute pulmonary embolism, APE). [methods] from December 2011 to December 2012, Department of Respiratory, second affiliated Hospital of Kunming Medical University, were examined by (computed tomography, CT), blood gas analysis and echocardiography. There were 54 cases of PE, diagnosed by CTPA as having no serious basic cardiopulmonary disease and no active bleeding, no anticoagulant therapy and no definite history of chronic thromboembolic disease in the near future. The blood gas analysis of CTPA and UCG, in 54 patients with APE was analyzed. The CT occlusion index was calculated by using the score method designed by Qanadli et al, and the right cardiac function parameters were measured by CT, mainly the cardiac and vascular diameters. The cardiac meridians include the right ventricular short axis maximum diameter (right ventricular short axis diameter, RVd), left ventricular short axis maximum diameter (left ventricular short axis diameter, LVd), right ventricular to left ventricular short axis maximum diameter ratio (RVd/LVd) and vascular diameters include the main pulmonary artery diameter (main pulmonary artery diameter, MPA), superior vena cava diameter (superior vena cava diameter, SVC). According to the CT pulmonary embolism index (PAOI),) of 54 patients with APE, according to PA0I30%,30% 鈮，

本文編號：2265757