超声心动图对下肢深静脉血栓患者无症状和轻微症状肺栓塞的筛查价值

ECHOCARDIOGRAPHIC VALUE OF SCREENING FOR ASYMPTOMATIC AND MILD SYMPTOMS PATIENTS WITH PULMONARY EMBOLISM AND DEEP VEIN THROMBOSIS

目的探讨超声心动图对下肢深静脉血栓(DVT)患者无症状和轻微症状肺栓塞(PE)的筛查价值。方法选择自2014年1月—2016年1月在该院入住的89例DVT患者为研究对象。入院后均进行CTPA检查,并根据检查结果分组:发生PE组(观察组)59例和未发生PE组(对照组)30例,观察组又分为症状典型的PE组33例以及无症状和轻微症状(症状不典型)PE组26例。(1)回顾性分析三组患者一般临床资料。(2)对患者空腹血浆D-二聚体阳性率进行分析。(3)比较三组患者经胸超声心动图检查结果。结果 (1)观察组与对照组比较外科手术史[54.2%(32/59)与16.7%(5/30)]、既往有无梗死史[3.4%(2/59)与10.0%(3/30)]、是否合并有心脏疾病[5.1%(3/59)与20.0%(6/30)]差异均有统计学意义(χ~2值分别为11.56、13.67、6.63,P均<0.05)。(2)89例DVT患者中有83例D-二聚体升高,观察组D-二聚体阳性率为94.9%(56/59),对照组为90.0%(27/30),二组间D-二聚体阳性率比较差异无统计学意义(χ~2=0.76,P=0.382)。(3)超声心动图结果显示观察组中33例症状典型PE患者右心室前壁厚度[(5.51±1.05)mm]、右心室流出道内径[(28.33±2.55)mm]、右心室舒张期横径[(42.35±2.13)mm]、主肺动脉内径[(30.37±3.01)mm]、肺动脉压[(48.57±2.37)mmHg]明显高于症状不典型PE组[(3.05±1.16)mm、(26.35±2.16)mm、(36.76±3.25)mm、(26.22±2.56)mm、(31.53±5.26)mmHg]和对照组[(2.93±1.03)mm、(17.21±1.53)mm、(34.24±3.13)mm、(17.80±1.01)mm、(24.53±2.37)mmHg],差异均有统计学意义(P均<0.01),而26例症状不典型PE组患者右心室流出道内径、主肺动脉内径、肺动脉压高于对照组,差异均有统计学意义(P均<0.01)。结论通过患者临床资料以及血生化检查结果,发现患者外科手术史、既往有梗死史、合并有心脏疾患与PE发生密切相关,而经胸超声心动图能早期检测出三尖瓣反流速度增快,肺动脉高压的征象,为临床早期发现无症状和轻微症状PE、评估患者病情及临床治疗提供依据,可作为对存在PE危险因素的人群的一种筛查手段。

Objective To investigate the value of echocardiography in the screening of asymptomatic and mild symptoms of pulmonary embolism （PE） in patients with deep vein thrombosis （DVT）. Methods Eightynine patients with DVT who were admitted to author＇s hospital from January 2014 to January 2016 were selected as the subjects. After admission were examined by CTPA,and according to the results of the inspection group： PE group （observation group） 59 cases and non PE group （control group） 30 cases and observation group was divided into the typical symptoms of 33 cases in PE group and asymptomatic and mild symptoms （symptoms） in 26 cases of group PE. General clinical data of 3 groups were analyzed retrospectively. The positive rate of fasting plasma D- two dimer and the results of transthoracic echocardiography were analyzed among the 3 groups. Results Compared the observation group with the control group on surgical history and,who had no history of infarction, with heart disease, the differences were statistically significant （P〈 0.05 ）. Eightynine cases of patients with DVT in 83 cases of D- two dimer increased, the observation group two D- dimer positive rate was 94.9% （56/59） ,the control group was 90% （27/30） ,no statistical significance between the two groups on the positive rate of D- two dimer （P = 0.382）. Echocardiography showed typical symptoms in the observation group of 33 cases of PE patients with right ventricular anterior wall thickness,right ventricular outflow tract diameter, right ventricular diastolic Qiheng diameter, diameter of main pulmonary artery and pulmonary artery pressure was significantly higher than that of atypical symptoms in PE group, the differences were statistically significant（P〈0.01）. And 26 cases of atypical symptoms of patients in group PE of right ventricular outflow tract diameter,diameter of main pulmonary artery and pulmonary artery pressure higher than that of the control group, the differences were statistically significant （P 〈0.01）.Conclusion In patients with the clinical data and blood biochemical examination results, we find that patients with previous surgical history,infarction history, with heart diseases is closely related to the occurrence of PE, and transthoraeic echocardiography can detect early three tricuspid regurgitation rate, signs of pulmonary hypertension,for clinical early detection of asymptomatic and mild the symptoms of PE, assessment of patients and provide the basis for clinical treatment, can be used as a screening tool for PE risk factors of population.