核素肺灌注显像对血压正常伴右室功能不全的急性肺栓塞症溶栓疗效的评价

Evaluation of radionuclide lung perfusion imaging to the effect of thrombolytic therapy in acute pulmonary embolism with normal blood pressure but right ventricular dysfunction

目的:运用核素肺灌注显像对血压正常伴右室功能不全的急性肺栓塞患者溶栓治疗前后肺血流灌注进行观察和定量分析,为临床疗效评价提供准确和直观的客观依据。方法:36例急性肺栓塞患者分为溶栓组和抗凝组,在治疗前后均行肺灌注显像。应用半定量法计算全肺灌注缺损百分数(percentage of pulmonary defect score,PPDs)和灌注改善百分数(percentage of pulmonary improve score,PPIs)。治疗前、治疗后7～10d及25～30d的PPDs分别记为PPDsD0、PPDsD10和PPDsD30。各组PPDsD0与PPDsD30之差、PPDsD0与PPDsD10之差、PPDsD10与PPDsD30之差分别记为PPIs、PPIsI1、PPIsI2。结果:溶栓组、抗凝组PPDs在治疗后均随时间显著降低(P<0.001);溶栓组PPIsI1明显大于抗凝组;两组PPIsI2无明显差异。在整个观察期间(治疗后1个月),溶栓组PPIs明显大于抗凝组。结论:溶栓治疗较单抗凝治疗能够更加迅速而持续地改善肺栓塞患者的肺血流灌注,应用肺灌注显像可以准确地评价患者治疗前后的肺血流变化。

Objective To assess the change of pulmonary perfusion by pulmonary radionuclide perfusion imaging in the patients with acute pulmonary embolism with normal blood pressure but right ventricular dysfunction in thrombolytic therapy. Methods Thirty-six patients with acute pulmonary thromboembolism, normal blood pressure and right ventficular dysfunction were enrolled into the study. All the patients, were divided into thrombolytic and anticoagulation group according to the treatment methods, accepted the radionuclide lung perfusion imaging before the therapy, 7 - 10 days and 20 - 30 days after treatment. Percentage of pulmobary defect scores （PPDs） was calculated by sem!quantitative analysis in pulmonary perfusion imaging before the therapy （PPDsD0）,7 - 10 days （PPDsD10） and 25 - 30 days （PPDsD30）after treatment. We further calculated the corresponding percentage of pulmonary improve scores （PPIs） according to the following equations： PPIsII= PPDsD0-PPDsD10, PPIsI2=PPDsD10-PPDsD30, PPIs= PPDsD0-PPDsD30. Results PPDs were decreased significantly after treatment in both thrombolytic group and anticoagulation group （P 〈 0.001）compared with pretherapy. Both PPIsI1 and PPIsI in thrombolytic group were significantly greater than those in anticoagulation group. Conclusion Our study suggests that thrombolytic therapy can improve more rapidly and more sustained the pulmonary blood perfusion than anticoagulant therapy in the patients with acute pulmonary embolism.