MSCT与超声心动图在急诊疑似主动脉夹层患者中的应用

Application of MSCT and Echocardiogram in Patients with Suspected Aortic Dissection in Emergency Department

目的研究多层螺旋CT(MSCT)与超声心动图在急诊疑似主动脉夹层患者中的应用。方法分别采用MSCT和经胸超声心动图(TTE)对94例疑似AD患者进行检查和诊断,然后将检查结果与增强CT血管造影(CTA)或手术结果进行对比,分析二者诊断准确性以及对疾病相关损害检出率,另比较MSCT和CTA对AD患者真假腔内径检测结果,进而分析TTE及MSCT在AD急诊患者中的应用价值。结果 TTE和MSCT对AD诊断;TTE和MSCT检测AD灵敏度分别为76.31%和92.11%,特异度分别为94.44%和88.88%,且MDCT对DebakeyⅠ型检出率高于TTE,差异有统计学意义(P<0.05),对DebakeyⅡ、Ⅲ型型检出率高于TTE,差异无统计学意义(P>0.05);MSCT对内膜片、血栓和心包积液检出率均高于TTE,对主动脉瓣损害检出率低于TTE,差异有统计学意义(P<0.05);MSCT与CTA所测真假腔内径差异无统计学意义(P>0.05)。结论TTE与MSCT均是安全有效的AD患者急诊检查方法,TTE诊断准确性稍低,但其操作更加简单方便,且能提供患者心功能和血流状态等参考信息;MSCT检查后期图像处理能力强大,能准确更多细节信息,可为手术方案和器材选择以及患者预后等提供参考。

Objective To explore the application of multi-slice spiral CT(MSCT and echocardiogram in patients with suspected aortic dissection(AD) in emergency department. Methods MSCT and transthoracic echocardiography(TTE) were used to examine and diagnose 94 patients with suspected AD, and then the results were compared with enhanced CT angiography(CTA) or surgical results, and the diagnostic accuracy of the two and the detection rates of disease-related damage were analyzed. The detection results of MSCT and CTA on the true or false lumen diameter of AD patients were compared, and then the application value of TTE and MSCT was analyzed in AD patients in emergency department. Results The sensitivities of TTE and MSCT in the detection of AD were 76.31% and 92.11% respectively, and the specificity were 94.44% and 88.88%,and the detection rate of Debakey I by MDCT was higher than that by TTE(P<0.05),and the detection rates of Debakey II and III were higher than those by TTE(P>0.05).The detection rates of intimal flap, thrombus and pericardial effusion by MSCT were higher than those by TTE, and the detection rate of aortic valve disease was lower than that by TTE(P<0.05). There was no significant difference in the true or false lumen diameter between MSCT and CTA(P>0.05). Conclusion Both TTE and MSCT are safe and effective methods for emergency examination of AD patients, and TTE has slightly low diagnostic accuracy, but its operation is more simple and convenient, and it can provide reference information of cardiac function and blood flow status. MSCT has strong image processing capability at the later stage, can conform more detailed information and can provide reference for the surgical regimens, equipment selection and patients prognosis.