彩色多普勒评价急性高危肺栓塞肺动脉压力增高的临床价值

Clinical value of color doppler in assessment of pulmonary artery pressure in patients with acute massive pulmonary embolism

目的探讨彩色多普勒观察肺动脉压力变化在急性高危肺栓塞诊断中的价值。方法按照2003年1月至2013年1月沈阳军区总医院门诊及住院的75例急性肺栓塞患者行彩色多普勒超声检查的结果。将患者分为A组(高危肺栓塞)20例,B组(中危栓塞组)40例和C组(低危肺栓塞)15例。选择同期正常对照组(D组)20名。主要采用胸骨旁四腔、五腔心及大动脉短轴等切面,充分显示三尖瓣及三尖瓣反流束,肺动脉瓣及肺动脉频谱,测量三尖瓣反流速度及压力阶差,评估肺动脉高压;测量肺动脉血流加速及射血时间。结果三尖瓣反流发生率及检出率均为100%,敏感度99%,特异度86%。三尖瓣反流速度及肺动脉压力增高,肺动脉加速时间及射血时间缩短,以A组最为严重,B组次之,C组则无明显改变。结论应用彩色多普勒评价急性高危肺栓塞患者的肺动脉压力增高程度,对于早期诊断急性高危肺栓塞具有重要意义。

Objective To explore the application value of echocardiography in detecting pulmonary artery pressure with pa- tients with acute massive pulmonary embolism （PE）. Methods A total of 75 patients were divided into three groups： a- cute massive PE group （ group A, n = 20）, acute submassive PE group （ group B, n = 40）, and acute non-massive PE group （group C, n = 15 ）. Meanwhile,20 normal controls were selected. All the patients were examined by Colour Doppler Ultra- sonography. Parasterual four-chamber view, five-chamber view and short axe1 of aorta view were used to observe tricuspid and its regurgitation, pulmonary value and pulmonary arterial flow spectrum. Tricuspid regurgitation velocity and pressure gradient （PG） were detected to evaluate pulmonary hypertension. Meanwhile,pulmonary artery blood flow acceleration time and ejection time were also measured. Results The incidence and detection rate of tricuspid regurgitation was 100% ,with a sensitivity of 99% and a specificity of 86%. Tricuspid regurgitation velocity and pulmonary artery pressure increased. Pul- monary artery blood flow acceleration time and ejection time were shorten most in group A and more in group B. There was no significant change in group C. Conclusion It is important to diagnose the acute massive pulmonary embolism with eval- uating the pulmonary artery pressure of the patient by co]our doppler.