肺灌注缺损百分数在急性肺栓塞危险分层中的价值探讨

Application value of percentage of pulmonary perfusion defect scores in predicting risk stratification of acute pulmonary embolism

目的 探讨肺灌注缺损百分数（PPDS％）对急性肺栓塞（APE）患者危险分层及预后判断的临床价值。方法根据2008ESC指南标准回顾分析2000年1月至2008年12月本院21例APE患者（A组）中低危10例、中危7例、高危4例的PPDS％，按此确定PPDS％对APE危险分层的参考值（PPDS％标准）。依据PPDS％标准对2009年1月至2011年6月本院34例APE患者（B组）进行危险分层，研究其临床不良事件发生率。结果A组中低危、中危、高危APE患者的PPDS％分别为（25．94±3．95）％、（45．63±4．38）％、（58．42±4．96）％（t34．755，P〈0．01）；B组34例APE患者按PPDS％标准分为低危17例、中危11例、高危6例，依据ESC指南分级为低危15例、中危13例、高危6例，二者的分级一致率为94．11％（32／34），其中高危患者的分级一致率为100．0％（6／6）。B组低危、中危、高危患者（依据PPDS％标准）分别有1例（5．89％）、3例（27．27％）、4例（66．67％）发生I临床不良事件，差异有统计学意义（x2=9．23，P〈0．01）。结论PPDS％可作为APE危险分层的重要参考指标，对指导临床决策及预后判断有重要价值。

Objective To investigate the clinical value of percentage of pulmonary perfusion defect score （PPDs%） for risk stratification and prognosis evaluation in patients with acute pulmonary embolism （APE）. Methods A retrospective study was carried out on PPDs% data of patients （ n = 21 ） with confirmed APE from January 2001 to December 2008. The patients were divided into three levels, low（ n = 10）, medial（ n =7） and high risk groups（ n =4）, according to 2008 ESC APE diagnosis and treatment guidelines. The reference index in predicting risk stratification by PPDs% was ascertained. 34 patients with confirmed APE were divided into three levels （ mild, moderate and severe risk levels ） according to the standard of PPDS% diagnosis from January 2009 to June 2011. A prospective study on the incidence rate of the clinical adverse events was performed. Results The PPDs% of low, medial and high risk levels according to 2008 ESC guidelines were （25.94± 3.95 ） %, （45.63± 4. 38） % and （ 58.42 ±4. 96 ） % respectively, with a significant difference （ t ≥4. 755, P 〈0. 01 ）. The standard of PPDS% diagnosis for risk stratification was confirmed in APE： low risk levels： PPDs% 〈 30%, moderate： 30% ≤ PPDs% 〈 50% , and high： PPDs% ≥ 50%. The mild, moderate and severe risk patients with APE were 17cases, 1 lcases and 6cases respectively, according to the standard of PPDs% diagnosis, or 15cases, 13cases and 6eases respectively, according to the standard of 2008 ESC guidelines. The uniform rate was 94. 11% for two methods; the uniform rate was 100. 00% in which high risk of APE. The mild, moderate and severe risk patients with APE according to the standard of PPDs% standard with clinical adverse events for were 1 case （5. 89% ）, 3cases （27.27%） and 4cases （66. 67% ） respectively, with a significant difference （X2 =9. 23, P 〈 0. 01 ）. Conclusions PPDs% could be used as an important reference index for risk stratification of diagnosis, selecting therapeutic programs, evaluating therapeutic efficiency and predicting the prognosis in patients with APE.