CTPA对急性肺动脉栓塞心血管参数及疗效的评价

Evaluation of cardiovascular parameters and efficacy in patients with pulmonary artery obstruction using computed tomography pulmonary angiography

目的探讨CT肺血管造影(CTPA)对急性肺栓塞患者治疗前后心血管参数变化评价的价值。方法收集临床疑诊肺栓塞病例152例,纳入118例,所有病例均行CTPA检查,其中40例为非肺栓塞(WPE组),肺动脉栓塞组78例,后者结合临床表现分为42例严重栓塞(SPE组),36例非严重栓塞(NSPE组)。严重栓塞组立即行溶栓治疗,非严重栓塞组则行抗凝治疗,于治疗14 d后行CTPA复查。以CTPA作为肺栓塞的诊断依据,分析三组之间的心血管参数的差异;分析肺栓塞组治疗前后的心血管参数的差异。结果对治疗前的心血管参数分析发现,三组间的双侧心室的最大短轴直径(cm)、双侧心室的最大面积(cm2),右室壁、左室壁和室间隔厚度(cm),奇静脉和上腔静脉的直径(cm),主肺动脉、右肺动脉和左肺动脉的直径(cm)均有统计学差异(P<0.001)。室间隔移位率及奇静脉或下腔静脉返流率亦有统计学差异(P<0.01)。SPE组与NSPE组治疗前后的上述心血管参数均有统计学差异。结论 CTPA不仅可以诊断肺动脉栓塞,还可以反映肺栓塞后心功能的改变,从而反映预后和观察疗效。

Objective To explore the value of computed tomography pulmonary angiography（CTPA） in evaluation of cardiovascular parameters of patients with acute pulmonary embolism before and after treatment.Methods A total of 118 patients clinically suspected as PE by CTPA were enrolled in this study.The patients were divided into 3 groups according to clinical severity：without PE（WPE）group（n=40）,server PE（SPE）group（n=42）,and non-severe PE（NSPE）group（n=36）.The patients were treated by fibrinolysis in SPE group and by heparin in NSPE group.CTPA were performed again after the treatment for 14 d.Based on the diagnosis of CTPA,difference of cardiovascular parameters among 3 groups was analyzed,and the cardiovascular parameters were observed and compared in PE patients before and after treatment.Results The cardiovascular parameters,including the maximum diameter of left and right ventricular short axis,the left and right ventricular maximum area,the right and left ventricular wall thickness and the interventricular septum thickness,the diameters of azygos vein and superior vena cava,the main pulmonary artery,the right and left pulmonary artery diameter,the rate of interventricular septum displacement,and the rate of reflux into the inferior vena cava showed significant difference before treatment among 3 groups.These parameters were also significantly different in SPE group and NSPE group before and after treatment.Conclusion CTPA can not only diagnose the pulmonary embolism,also evaluate the changes of right heart function and reflect the prognosis and curative effect.