经胸超声心动图在肺动脉栓塞诊断中的应用价值

Application Value of Transthoracic Echocardiography in the Diagnosis of Pulmonary Embolism

目的：探讨经胸超声心动图（TTE）对肺动脉栓塞（PE）的诊断价值。方法：回顾性分析21例经CT肺动脉造影检查确诊为PE患者的经胸超声心动图表现。结果：本组21例，经胸超声心动图大致正常者6例；直接检出主肺动脉及左、右肺动脉近段血栓8例；间接征象提示右心负荷过重15例（包括8例直接检出血栓者），均有右心扩大的表现，其中右室内径（30．7±5．4）mm，右房内径（59．4±6．6）mm。彩色多普勒观察到三尖瓣返流16例，检测其返流速度估测出肺动脉收缩压增高15例，收缩压均高于40mmHg。结论：经胸超声心动图对中央型肺栓塞具有较高的诊断价值，它可以显示血栓发生的部位。对周围型（肺段及远端分支）肺栓塞虽然不能直接做出诊断，但根据右心扩大、三尖瓣返流及肺动脉高压等间接征象，可为肺动脉栓塞的诊断提供佐证，为临床诊断提供帮助。

Objective：To assess the value of transthoracic echocardiography （TIE） in the diagnosis of pulmonary embolism （PE）. Methods：Echocardiography performance of 21 cases of CT pulmonary angiography diagnosed as PE was analyzed. Results： Among 21 patients, Generally normal transthoracic echocardiography diagram was in 6 patients; direct detection of the main pulmonary artery , 8 cases were proximal thrombosis of the left and the right pulmonary artery ; indirect signs suggested that right heart overloading was in 15 cases , who had performance of the right heart expansion , the right ventricular diameter was （ 30.7± 5.4） mm, right atrial diameter was （59.4± 6.6）mm. 16 cases were observed tricuspid regurgitation by color Doppler, Reflux speed was detected, the pulmonary artery systolic pressure increased in 15 cases, systolic blood pressure was higher than 40mmHg. Conclusions：Transthoracic echocardiography has a high diagnostic value in central pul- monary embolism ; it can display the site of thrombosis. Peripheral （ lung segment and remote branch） pulmo- nary embolism can not directly diagnose, but it can provide evidence for the diagnosis of pulmonary embolism and the clinical diagnosis based on enlarged right heart, tricuspid regurgitation and indirect signs of pulmonary hypertension.