超声心动图右心功能指标在肺血栓栓塞症溶栓前后的变化

Changes of right ventricular indexes on echocardiography in pre-and post-pulmonary embolism thrombolysis

目的通过超声心动图检测大面积和次大面积肺血栓栓塞症(PTE)患者溶栓前后的右心功能指标,评价急性期溶栓效果。方法 29例患者(大面积者8例,次大面积者21例),其中男性10例,女性19例;年龄30～75岁,平均年龄59岁(标准差12岁)。均接受溶栓治疗。溶栓前和溶栓后24h观察超声心动图检查指标:左右心室舒张末期前后径(LVED、RVED)、左右心室舒张期横径(LVDD、RVDD)、左右心房舒张期横径(LADD、RADD)、右心室前壁厚度(RVAWT)、右心室前壁运动幅度(RVAWM)、主肺动脉内径(PAD)、三尖瓣反流压差(TRPG)、肺动脉收缩压(SPAP)。计算RVED/LVED、RVDD/LVDD和RADD/LADD比值。结果除RADD外(P=0.041),溶栓前大面积PTE组和次大面积PTE组患者间各指标未见显著性差异。溶栓后大面积者RVAWM、LVED和LADD明显升高(P=0.024,P=0.003,P=0.043);次大面积者LVED明显升高(P=0.001),RVDD、RADD、RADD/LADD比值、TRPG和SPAP明显下降(P=0.003,P=0.016,P=0.006,P<0.001,P<0.001)。结论溶栓治疗可改善PTE患者右心功能不全,超声心动图对PTE的疗效评价有重要意义。

Objective To evaluate the effect of thrombolysis by comparing the right ventricular indexes on echocardiography before and after thrombolysis on massive and submassive pulmonary thromboembolism（PTE）.Methods A total of 29 PTE patients（8 massive and 21 sub-massive） were enrolled,male 10,female 19,aged 30-75 years old,mean aged 59 years old（± 12 years old）,who received thrombolytic therapy.The right ventricular indexes on echocardiography were monitored before thrombolytic treatment and 24-hour after thrombolysis,such as right/left ventricular end-diastolic diameter in the parasternal long-axis view（LVED,RVED）,diastolic diameters of right/left ventricular（LVDD,RVDD）,diastolic diameters of right/left atrium（LADD,RADD）,right ventricular anterior wall thickness（RVAWT）,right ventricular anterior wall movement（RVAWM）,main pulmonary artery diameter（PAD）,tricuspid regurgitant pressure gradient（TRPG） and systolic pulmonary artery pressure（SPAP）.The ratio of RVED/LVED,RVDD/LVDD and RADD/LADD were calculated.Results There was no difference between massive and sub-massive PTE at pre-thrombolysis of all index but RADD（P = 0.041）.The RVAWM,LVED and LADD increased significantly（P = 0.024,P = 0.003,P = 0.043） in the massive PTE at post-thrombolysis;LVED increased remarkably（P = 0.001）,RVDD,RADD,the ratio of RADD/LADD,TRPG and SPAP declined significantly（P = 0.003,P = 0.016,P = 0.006,P 0.001,P 0.001） in submassive PTE after thrombolysis.Conclusion It is demonstrated that thrombolysis therapy could improve the right ventricular dysfunction in PTE,and the echocardiography play an important role in the therapeutic evaluation.