回顾性心电门控多层螺旋CT对急性肺栓塞右心室功能障碍及溶栓前后右心室功能变化的评价

Assessment of right ventricular dysfunction and the metergasis before and after therapy of thrombolysis with electrocardiography gated multi-detector spiral CT in acute pulmonary embolism

目的 应用ECG门控MSCT前瞻性对中心型急性肺动脉栓塞（APE）患者右心功能障碍及静脉溶栓前后右心功能变化进行评价.方法 96名可疑APE患者进行了ECG门控MSCT胸痛三联检查,25例确诊为中心型肺栓塞.行胸痛三联检查无心肺疾患且性别、年龄匹配的25例作为对照组.APE患者于静脉溶栓后复查MSCT,评价右心功能恢复情况.测量参数包括横断面舒张期的右心室（RV）及左心室（LV）短轴最大内径,RV及LV舒张末期容积（EDV）、收缩末期容积（ESV）、射血分数（EF）、主肺动脉/主动脉直径比.应用单因素方差分析,如果有统计学意义,则采用两两组间q检验.结果 对照组的右心室EDV、ESV、EF值、收缩末期RV/LV容积比、横断面RV/LV内径比及主肺动脉/主动脉直径比分别为（15O.5±24.1）ml、（71.5±18.5）ml、（53.5±4.2）%、1.08±0.04、1.01±0.04及0.99±0.02,中心型APE患者溶栓前以上各值分别为（190.3±16.2）ml、（128.1±13.2）ml、（32.7±3.6）%、2.00±0.26、1.30±0.09及1.34±0.11,溶栓后分别为（159.2±21.5）ml、（80.7±9.4）ml、（49.2±5.9）%、1.22±0.25、1.02±0.02及1.02±0.11.中心型APE患者与对照组比较,右心室ESV（q=6.28,P〈0.01）及EDV均增大（q=7.59,P〈0.01）,EF减小（q=4.82,P〈0.01）,收缩末期RV/LV容积比增大（q=6.04,P〈0.01）,横断面RV/LV内径比（q=4.43,P〈0.01）及主肺动脉/主动脉直径比增大（q=4.36,P〈0.01）,左心室EDV减小.中心型APE患者静脉溶栓后,与溶栓前比较,右心室ESV（q=5.03,P〈0.01）及EDV减小（q=6.11,P〈0.01）,EF增加（q=6.29,P〈0.01）,收缩末期RV/LV容积比减小（q=4.74,P〈0.01）,横断面RV/LV内径比（q=3.83,P〈0.01）及主肺动脉/主动脉直径比减小（q=3.46,P〈0.01）,左心室EDV增大（q=4.01,P〈0.01）.结论 回顾性ECG门控MSCT胸痛三联检查可同时检测APE和测量左右心功能,排除其他胸痛疾病,评价溶栓疗效.

Objective To prospectively assess right ventricular dysfunction and the metergasis before and after therapy of thrombolysis with ECG gated multi-detector spiral computed tomography （MSCT）in patients with acute pulmonary embolism. Methods Triple rule-out ECG gated MSCT examination was performed in 96 consecutive patients suspected of PE. 25 patients with central PE were confirmed. 25 agematched subjects without cardiac and pulmonary disease were recruited as control group. Triple rule-out ECG gated MSCT were performed again to assess cardiac function after therapy of thrombolysis. Dimension ratios for the right ventricle （RV） and left ventricle （ LV）, main pulmonary artery and aorta were measured.Furthermore, the RV and LV end-diastolic volumes （EDV）, end-systolic volume （ESV） and ejection fraction （EF） were also measured. The mean values were compared with analysis of variance （ANOVA） and Newman-Keuls test before and after thrombolysis. Results The mean values of RVEDV, RVESV, RVEF,RV/LV ESV volume ratio, RV/LV dimension ratio and main pulmonary artery/aorta dimension ratio in control group were （150.5±24.1） ml,（71.5 ±18.5） ml, （53.5 ±4.2）%, 1.08 ±0.04, 1.01 ±0.04 and 0. 99 ±0. 02, respectively. While those in PE group were （ 190. 3 ± 16. 2） ml, （ 128. 1 ± 13.2） ml,（32.7 ± 3.6 ） %, 2.00 ± 0.26, 1.30 ± 0. 09 and 1.34 ± 0. 11, respectively. Those after therapy of thrombolysis were （ 159. 2 ± 21.5 ） ml, （ 80. 7 ± 9.4） ml, （49. 2 ± 5.9） %, 1.22 ± 0.25, 1.02 ± 0.02 and 1.02±0.11,respectively. ESV and EDV of RV were larger （q= 6.28, P〈0.01 q=7.59, P〈0.01）,EF value was lower （q = 4. 82, P 〈 0.01 ） in PE group than those in control group. RV/LV ESV volume ratio, the RV/LV dimension ratio and main pulmonary artery/aorta dimension ratio were larger （ q = 6. 04,P 〈0. 01 q =4. 43, P 〈0. 01 q =4. 36, P 〈0. 01 ） and EDV of LV was lower in PE group than those in control group. However, ESV and EDV of RV and RV/LV ESV volume ratio were lower （q = 5.03, P 〈0.01 q=6. 11,P〈0.01 q=4.74,P〈0.01）, EF value was larger （q=6.29, P〈0.01） and EDV of LV was larger（q =4.01 ,P 〈0.01 ） after therapy of thrombolysis than before. Conclusion Retrospective triple rule-out ECG-gated MSCT can show pulmonary embolism, measure the function of RV and LV and evaluate curative effect of thrombolysis.