急性肺血栓栓塞危险分层的探讨

Study of risk stratification in acute pulmonary thromboembolism

目的联合应用血清TnI和超声心动图检查对血压正常的急性PTE患者进行分组比较,了解其与预后的关系,试图筛选出高危患者。方法根据血清TnI水平和超声心动图检查将急性PTE患者分为四组:血清TnI水平升高且存在右心运动功能减弱(Group 1)、血清TnI水平未升高但存在右心运动功能减弱(Group 2)、血清TnI水平升高且无右心运动功能减弱(Group 3)、血清TnI水平未升高且无右心运动功能减弱(Group 4)。结果77例血压正常的急性PTE患者,Group 1组13例(17%),Group 2组10例(13%),Group 3组22例(29%),Group 4组32例(42%)。四组间呼吸困难、颈静脉充盈、P2心音亢进、右房室瓣杂音、心率差异有统计学意义(P=0.0300、.006、0.010、0.032、0.031);Group 1组与其他三组之间差异有统计学意义(P<0.01)。四组间动脉血PaO2、P(A-a)O2差异有统计学意义(P<0.01)。四组预后不良者分别为9例(68%)、3例(30%)、5例(23%)、0(0%),差异有统计学意义(P=0.032)。结论联合应用血清TnI和超声心动图检查在血压正常的急性PTE患者中可能筛选出高危患者。

Objective Combine serum cardiac troponin Ⅰ（TnⅠ）and echocardiography tocompare the differences among pulmonary thromboembolism（PTE）patients with normal bloodpressure and to find the relationship between these two factors and prognosis. Try to screen outthe high- risk patients. Methyl According to serum TnI levels and echocardiography ： Groupl （ serum TnI elevation combined with a positive echocardiography）, group2（ no serum TnⅠ elevation but positive echocardiography）, group3（ serum TnⅠ elevation increased and negdtive echocardiography ）and group4（no serum TnⅠ elevation and negdtive echocardiography）. Results In the 77 patients with acute PTE, 13 （17 % ）in group 1,10 （ 13 % ） in group 2, 22 （29 % ）in group 3,32 （42 % ） in group 4. There are significant difference in dyspnea, jugular engorgememt, accentuated P2, tricuspid regurgitation murmur, tachycardia（ P = 0. 030, 0. 006,0.010,0.032,0.031 ）. Group 1 is significant different from the other 3 groups（ P 〈 0.01 ）. ＇And there are significant difference among these 4 groups in arterial PaO2, P（ A - a） O2 （ P 〈 0. 01）. Patients who suffer from poor prognosis in each group are 9 （ 68% ）, 3 （ 30% ）, 5 （ 23% ）, 0 （ 0% ） respectively. The differences are significant （ P =0.032）.Conclusion It is a good method to combine serum TnⅠ and echocardiography to screen high risk patients among acute PTE patients with normal blood twessure.