多普勒超声心动图对急性肺动脉栓塞的诊断特点及分析

Characteristics of Doppler echocardiography for diagnosing acute pulmonary embolism

目的 应用多普勒超声心动图分析无心肺基础病变急性肺动脉栓塞 (PE)患者肺动脉血流频谱特点及对PE的诊断价值。方法 应用多普勒超声心动图检测无心肺基础病变的急性PE患者肺动脉血流频谱曲线 ,与肺动脉造影、肺核素扫描及血气分析对照。结果 多普勒超声检测 17例发病 2h至 11d[平均 ( 5 .1±7.7)d]PE患者肺动脉血流频谱曲线 ,14例频谱曲线形态呈现双峰 ,表现高阻力低灌注的特点。计算收缩早期峰时明显小于收缩中晚期峰时 ,其比值平均 0 .5 6± 0 .16。收缩中晚期血流速度明显减低 [( 37.5± 10 .9)cm svs( 70 .4± 2 3 .8)cm s] ,早期峰时速度与收缩晚期速度比值 1.6 7± 0 .2 6。早期血流加速时间 (AT )及血流减速时间(DT)明显缩短 [分别为 ( 4 0 .8± 9.7)ms ,( 5 7.3± 12 .3)ms]。 15例检出三尖瓣反流 ,反流压差 >30mmHg[( 5 8.1± 18.7)mmHg] ,3例发现右心系统血栓的直接证据。出现肺动脉血流高阻力低灌注特征的 14例PE患者经肺动脉造影和 (或 )肺通气灌注扫描证实为肺动脉主干或主支中至大块血栓栓塞。 17例PE患者均出现急性肺源性心脏病表现。结论 多普勒超声心动图检测中至大块急性PE肺动脉血流频谱曲线 ,呈现高阻力低灌注的双峰特征 ,对快速早期提示急性PE具有重要的临床应用价值。

Objective To investigate the characteristics of pulmonary circulation and their diagnostic values in patients with acute pulmonary embolism (PE) who had no cardiopulmonary disease history by Doppler echocardiography.Methods The pulmonary blood waves were detected by Doppler echocardiography,which were compared with the results of pulmonary angiography, nuclide scintiscanning and blood gas analysis.Results The pulmonary blood waves displayed the style of double peak in systole and high resistance as well as low perfusion in 14 from 17 cases of PE 2 hour and 11 day [( 5.1 ± 7.7 ) d ] after onset. The duration of peak in early systole was shorter than that in late systole significantly, and the mean ratio between them was 0.56 ± 0.16 .The blood velocity of mid late systole was decreased more obviously than that of early systole′s [( 37.5 ± 10.9 )cm/s vs ( 70.4 ± 23.8 )cm/s]; and the ratio of the latter / former was 1.67 ± 0.26 .Both AT and DT during early period were significantly shorter [( 40.8 ± 9.7 )ms and ( 57.3 ± 12.3 )ms, respectively]. Tricuspid regurgitations (TR) were more than 30 mm Hg [( 58.1 ± 18.7 )mm Hg]. The evidence of right ventricle thrombuses were found in 3 cases. There were mid big mass of thromboembolism or >8 segments of perfusion defect in pulmonary main artery or branches showed in 14 PE cases with the features of high resistance and low pulmonary circulation perfusion. All 17 cases of PE presented with clinical manifestations of acute pulmonary heart disease.Conclusion It has a certain clinical value for diagnosis of PE cases to display the double peaks of high resistance and low perfusion in systole by Doppler echocardiography.