肺动脉栓塞中发生肺梗死的CT表现及相关因素分析

Analysis of CT findings and correlative factors for pulmonary infarction complicated with pulmonary embolism

目的采用多因素回顾性分析探讨肺动脉栓塞(PE)并发肺梗死(PI)的相关因素,并评价CT对PI的诊断价值。方法50例经CT肺动脉造影(CTPA)确诊的PE患者,对PI组18例和非PI组32例患者基础心肺疾患、发病到确诊的时间间隔、肺动脉栓塞指数、中央肺动脉受累比例、支气管动脉扩张显示率进行对比分析,探讨PE并发PI的相关因素。结果本组PE中18例合并PI;PI组的栓塞指数、中央肺动脉受累比例、心肺基础疾患率经统计学分析均高于非PI组(Z=2.65、χ2=5.23、χ2=9.09,P<0.05);两组发病到确诊的时间间隔、支气管动脉扩张显示率经统计学分析差异无统计学意义(Z=1.74,χ2=0.10,P>0.05)。结论PE患者栓塞指数、中央肺动脉受累比例、心肺基础疾患是影响PI发生的重要因素;发病到确诊的时间间隔、支气管动脉扩张和治疗方式与PI无明显相关性;CT随访对鉴别出血性肺不张和PI有重要价值。

Objective To investigate the correlative factors of pulmonary embolism （PE） complicated with pulmonary infarction （PI） by adopting multi-factor retrospective analysis and evaluate the value of CT in diagnosing PI. Methods Fifty patients with PE confirmed by computed pulmonary angiography （CTPA） were selected into the research, in which 18 cases of PI group and 32 cases of non-PI group were analysed comparatively in studying the patients＇ previous cardiac and pulmonary diseases, the interval from onset to confirmation, the embelismic index of PE, the involving proportion of central pulmonary arteries and the presenting proportion of dilated bronchial arteries. Results Eighteen cases of PE in this group accompanied with PI. The embolismic index, the involving proportion of central pulmonary arteries anti the ratio of previous cardiac and pulmonary diseases of PI group were all higher than those of non-PI group in statistic analysis （ Z = 2. 65,X^2 = 5.23, X^2 = 9.09, P 〈 0. 05 ）. The interval from onset to confirmation and the presenting proportion of dilated bronchial arteries had no significant difference in statistic analysis between two groups（ Z = 1.74, X^2 = 0. 10 ;P 〉 0. 05 ）. Conclusion The embolismic index, the involving proportion of central pulmonary arteries and the previous cardiac and pulmonary diseases of PE patients are the crucial predictive factors for occurrence of PI, while the interval from onset to confirmation and the dilation of bronchial arteries and the therapeutical methods have no distinct correlation with the occurrence of PI. Follow-up CT examination is significantly valuable to the differentiation between hemorrhagic pulmonary atelectasis and PL.