彩色多普勒超声心动图和下肢深静脉彩色多普勒超声在急性肺栓塞诊断及疗效评估中的应用价值

The significance of echocardiography in the diagnosis and treatment of acute pulmonary embolism

目的研究彩色多普勒超声心动图(CDE)在急性肺栓塞(APE)诊断与治疗效果评价中的临床应用价值。方法选择经CT肺动脉造影(CTPA)或核素肺通气与灌注扫描确诊为APE患者385例进行CDE及下肢深静脉彩色多普勒超声检查结果分析,经胸二维超声重点观察右房室腔大小和功能状态、右室壁运动及下腔静脉情况;用彩色多普勒观察血流状态,连续多普勒测量三尖瓣最大反流速度,以三尖瓣反流压差法计算出肺动脉收缩压(SPAP),观察患者静脉系统及其随呼吸变化的情况,检测患者下肢静脉血栓的部位和形态。结果检出肺动脉主干及分叉处血栓直接征象4例(1.04%),右心异常改变228例(59.22%),其中右心房、右心室不同程度扩大并肺动脉增宽133例(58.33%);单纯肺动脉增宽63例(16.36%),心包积液28例(7.27%),右室肥厚4例(1.04%),室间隔运动幅度减低3例(0.78%),下腔静脉增宽、下腔静脉随呼吸变化率降低4例(1.04%)。183例(47.53%)患者轻度至中度三尖瓣反流,183例(47.53%)患者SPAP轻至中度升高,范围41～73mmHg,平均(56±11.52)mm-Hg,治疗后SPAP下降至(26.02±1.69)mmHg。220例(57.14%)患者检出下肢深静脉血栓,17例(4.42%)血流缓慢、淤滞。结论系统全面、动态的CDE及下肢深静脉彩色多普勒超声检查,对于APE患者右心系统尤其是肺动脉腔内血栓的检测、心脏结构的改变、SPAP的估测、下肢深静脉血栓的检测、疗效评估、预后及随访均有重要临床价值。

Objective To evaluate the feasibility and clinical value of color Doppler echocardiography （CDE） and deep venous color Doppler ultrasonography in the diagnosis and treatment of acute pulmonary embolism （APE）. Methods 385 consecutive patients with acute pulmonary embolism underwent color Doppler echocardiography and deep venous color Doppler ultrasonography. Results Thrombus within the main pulmonary artery and right pulmonary artery was detected in four patients, right ventricular dysfunc-tion was found in 228 patients, pulmonary hypertension was found in 183 patients, proximal vein thrombosis was detected in 220 pa- tients, and slow blood flow stasis was detected in 17 patients. Conclusion Comprehensive system, dynamic color Doppler echocardio-graphy and lower extremity deep venous color Doppler ultrasound, especially right heart system for patients with acute pulmonary embol- ism pulmonary intraluminal thrombus detection of cardiac structure changes, SPAP estimation detection of deep venous thrombosis, effi-cacy assessment, prognosis and follow-up are important.