肺栓塞肺动脉血流波形的观测

Observation of blood flow waveform in the pulmonary arteries of patients with pulmonary embolism

目的了解肺动脉血流波形的变化在肺栓塞诊治中的应用意义。方法利用多普勒超声检测了21例经CT、ECT及肺动脉造影证实的肺动脉栓塞患者的肺动脉血流,并对这些患者治疗前后的肺动脉血流波形的改变进行了比较分析。结果轻中度肺动脉高压17例,重度4例;多普勒超声检出了收缩早期突然加速、加速肢上升陡直、流速峰值前移、而后提前减速的肺动脉血流频谱15例,即频谱波形呈“拳指状”,2例可见收缩晚期第二个较低的峰;峰值流速明显减低<80cm/s14例,7例患者的流速在正常范围;溶栓治疗48h后,“手指状”肺动脉频谱波形逐渐消失,1周后恢复正常倒等腰三角形肺动脉血流波形14例,7例的肺动脉血流波形治疗前后变化不明显,但患者的肺动脉内栓子明显缩小。结论多普勒超声观测肺动脉血流波形的变化,不单可用于肺栓塞的诊断,在肺栓塞治疗疗效评价方面也可成为客观的影像学指标。

Objective To understand the changes of blood waveform in the pulmonary arteries of patients with pulmonary embolism（PE）. Methods Twenty-one patients with clinically diagnosed PE, through CT, ECT and pulmonary angiography, were examined by Doppler echocardiography before and after the treatment. Results There were 17 cases of mild-mid pulmonary hypertension and 4 cases of severe pulmonary hypertension in this study. A blood wave with ＂fist-finger like＂ sign was detected in 15 cases＂ pulmonary arteries, while 2 cases displayed a style of double-peak in systole. Peak velocity of pulmonary artery was less than 80 cm/s in 14 cases, and normal in 7 cases. The pulmonary blood wave with ＂fist-finger like＂ sign disappeared in 14 cases whose clinical manifestation improved apparently after treatment. Conclusion Changes of the pulmonary blood wave style on the Doppler spectra could not only be used for the diagnosis of PE, but also be used as an index to evaluate the effects of the treatment of PE.