超声心动图联合脑钠肽检测评价急性肺栓塞溶栓治疗效果

Value of combined echocardiography and brain natriuretic peptide levels in acute pulmonary embolism treated by thrombolysis

目的探讨超声心动图联合血浆脑钠肽（brain natriuretic peptide，BNP）检测在急性肺栓塞（acute pulmonary embolism，APE）溶栓治疗中的价值。方法确诊APE且超声提示有右心压力超负荷征象患者31例进行溶栓治疗，分别在溶栓前和溶栓后24～48h行超声、肺通气-灌注显像检查及BNP检测。结果26例溶栓有效，溶栓后其肺动脉收缩压由（57．3±18．2）mmHg降至（40．4±15．4）mmHg（P=0．003），右室舒张末径由（40．6±6．1）mm减小为（35．4±6．0）mm（P〈0．01），肺动脉内径由（27．2±4．9）mm减小为（22．5±4．4）mm（P=0．004），左室舒张末径由（42．4±7．2）min增加为（43．1±6．9）mm（P=0．42），室间隔矛盾运动者由20例减少为10例，血浆BNP由（278．8±43．3）ng／L下降为（119．1±40．4）ng／L（P=0．00001）。5例溶栓无效，溶栓前后超声心动图各参数无明显变化，但血浆BNP由（431．8±57．7）ng／L增加为（496．4±70．3）ng／L（P=0．03）。血浆BNP水平与肺动脉收缩压有较好相关关系（r=0．62，Pd0．01）。结论溶栓治疗能迅速改善APE患者的肺灌注和右心功能。超声联合BNP水平检测可敏感地反映溶栓治疗中的血流动力学变化，准确评价疗效。

Objective To explore the value of combined echocardiography and brain natriuretic peptide （BNP） levels in acute pulmonary embolism （APE） treated by thrombolysis. Methods Echocardiography,pulmonary ventilation-perfusion imaging and plasma BNP levels were performed before thrombolysis and 24 - 48 h after thrombolysis in 31 patients with diagnosis of APE and signs of right ventricular pressure overload. Results Twenty-six patients with thrombolysis effective,after thrombolysis, the pulmonary artery systolic pressure decreased from （57.3 ＋ 18.2）ram Hg to （40.4±15.4）ram Hg （ P = 0. 003） ,the right ventricular diastolic diameter reduced from （40.6±6.1）ram to （35.4 ±6.0）ram （ P 0.0l） ,the pulmonary artery diameter reduced from （27.2±4.9）ram to （22.5±4.4）mm （ P = 0. 004） ,the left ventricular diastolic diameter increased from （42.4±7.2）mm to （43.1±6.9）ram （ P = 0.42）, septal contradiction were reduced from 20 cases to 10 cases （ P = 0.02）, plasma BNP levels decreased from （278.8± 43.3）ng/L to （119.1 ± 40.4）ng/L （ P = 0. 000 01）. Five patients with thrombolysis ineffective, there were no significant changes before and after thrombolytic therapy in the parameters of echocardiography, however, plasma BNP levels increased from （431.8 ± 57.7）ng/L to （496.4±70.3）ng/L （ P = 0.03）. Plasma BNP levels and pulmonary artery systolic pressure had a better relationship（ r = 0.62, P 〈0.01）. Conclusions The pulmonary perfusion and right ventricular function in patients with APE can be rapidly improved by thrombolytic therapy. Combined echocardiography and the BNP levels is a sensitive index in the hemodynamic changes of thrombolytic therapy,and can evaluate the treatment accurately.