超声心动图对肺栓塞诊断价值的研究

The role of echocardiography in pulmonary embolism

目的 探讨经胸超声心动图 (TTE)和经食管超声心动图 (TEE)对肺栓塞的诊断价值。方法 对10例临床疑诊肺栓塞患者进行了TTE和TEE检查 ,并与CT结果对照 ,其中 4例患者进行了治疗后TEE随访。结果 10例患者右心房内径 (5 7± 9)mm ,右心室内径 (3 4± 5 )mm ,肺动脉收缩压 (91± 19)mmHg(1mmHg=0 .13 3kPa) ,所有患者均有中度 -重度三尖瓣反流。检出右肺动脉内活动性血栓 2例 ,附壁血栓 2例 ,右心室活动性血栓 2例 ,左肺动脉活动性血栓 3例 ,附壁血栓 1例。 10例患者中 4例为左肺动脉或右肺动脉远段血栓 ,由TEE检出。所有结果经CT或手术证实。溶栓加抗凝治疗 3例 ,手术治疗 1例 ,2 0d～ 3个月后随访TEE ,肺动脉内血栓明显缩小或消失 ,肺动脉压力下降。结论 超声心动图技术在检出右心系统和肺动脉内血栓、明确肺栓塞的临床类型、评价肺栓塞的血流动力学改变和随访治疗效果等方面具有重要价值 ;

Objective To evaluate the potential use of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in patients with pulmonary embolism.Methods TTE and TEE were performed in 10 patients with suspected pulmonary embolism.The results of echocardiography were compared with that of computed tomography (CT).Four patients treated by thrombolysis or pulmonary thromboendarterectomy were follow up by TEE.Results Right heart overload was identified echocardiographically by the presence of dilation of right atrium (57±9)mm,right ventricle (34±5)mm; secondary tricuspid regurgitation; and increased pulmonary systolic pressure (91±19)mm Hg(1 mm Hg= 0.133 kPa).The mobile,snakelike,unattached thrombi were detected in right pulmonary artery in 2,left pulmonary artery in 3,and right ventricle in 2 cases.The Sessile,mural,immobile thrombi were presented in right pulmonary artery in 2 and left pulmonary artery in 1 cases.Thrombi in distal left and right pulmonary artery were detected in 4 patients by TEE.Twenty days to 3 months follow up by TEE showed that thrombi in distal left and right pulmonary artery disappeared and the systolic pulmonary artery pressure decreased.Conclusions Echocardiography is of great value in detection of thrombi in right heart and pulmonary artery,and evaluation of right heart overload.Echocardiography is a useful method in follow up of patients after treatment by thrombolysis or pulmonary thromboendarterectomy.More importantly,the ability of TEE to detect emboli in the distal left and right pulmonary artery is proved