超声检查在老年急性肺栓塞诊断及疗效评估中的价值

Value of ultrasonography in diagnosis and treatment of acute pulmonary embolism in the elderly

目的探讨超声检查在老年急性肺栓塞诊断及疗效评估中的价值。方法选择老年急性肺栓塞患者27例,所有患者均于急性肺栓塞发病前、发病时以及治疗病情缓解后进行超声心动图、下肢深静脉超声检查,并行末梢血氧饱和度、血压、血浆D-二聚体等检测。结果与发病前比较,老年急性肺栓塞患者发病时收缩压、舒张压、末梢血氧饱和度明显下降,血浆D-二聚体明显升高,差异有统计学意义(P<0.05)。经治疗病情缓解后,患者的血压、末梢血氧饱和度均恢复或接近急性发病前的平时水平,血浆D-二聚体明显下降(P<0.05)。急性肺栓塞发病时,患者右心房、右心室增大,主肺动脉及下腔静脉增宽,三尖瓣反流速度增快,肺动脉收缩压明显增高,与发病前比较,差异有统计学意义(P<0.05)。经治疗病情缓解后,患者右心房、右心室、主肺动脉及下腔静脉均恢复或接近急性发病前的平时水平,三尖瓣反流速度及肺动脉收缩压明显下降。老年急性肺栓塞患者发病时下肢深静脉血栓超声检出率高达77.8%。结论超声心动图及下肢深静脉超声同时结合其他各类检查是老年急性肺栓塞诊断必不可少的辅助检查手段,为老年急性肺栓塞的早期诊断、治疗及疗效评估提供有力的帮助。

Objective To study the value of ultrasonography in diagnosis and treatment of acute pulmonary embolism （APE） in the elderly. Methods Twenty-seven elderly APE patients were in cluded in this study. The patients underwent echocardiography, lower extremity deep vein ultra sonography, distal hemooxygen saturation test, blood pressure and plasma D-dimer level measurement before the onset,at the onset and after treatment of APE. Results The systolic and diastolic blood pressure and distal hemooxygen saturation level were significantly lower while the serum D-dimer level was significantly higher at the onset of APE than before the onset of APE in elderly APE patients （P〈0.05）. The blood pressure and distal hemooxygen saturation level returned to normal while the serum D dimer level decreased significantly after treatment （P 〈0. 05）. The right atrium and ventricle were significantly larger, the pulmonary aorta and inferior vena cava were significantly wider, the reflex speed in tricuspid valve was significantly rapider, and the systolic pressure of pulmonary artery was significantly higher after treatment than before treatment. The incidence of deep vein embolism in lower extremity was 77.8% detected by ultrasonography in elderly APE patients. Conclusion Echocardiography and lower extremity deep vein ultrasonography in combination with other clinical tests are necessary for the early diagnosis and treatment of APE in the elderly.