急性肺动脉栓塞患者心脏CT测量研究

Study on the measurement of cardiac CT in patients with acute pulmonary embolism

目的通过测量分析急性肺动脉栓塞(APE)患者心脏各心腔大小,并与健康对照组进行对比分析,探讨APE患者心脏形态学变化规律。方法回顾性分析经临床确诊的75例APE患者,根据Qanadli评分法分为栓塞指数≥50%(c组)33例与<50%(b组)42例,并与56例对照组(a组)进行对比,分析心脏各心腔的左右径(LR)及前后径(AP)的变化。结果c组与a、b两组对比,右心室LR、右心室AP、右心房LR均明显增大(P<0.05),左心室LR明显减小(P<0.05)。b组与a组对比,右心室LR、右心房AP明显增大(P<0.05),左心房LR明显减小(P<0.05)。而左心房AP,b组大于a组与c组(P<0.05)。左心室AP,三组间无显著差异(P>0.05)。三组间各径线的两心房比(RA/LA)、两心室比(RV/LV)均差异有统计学意义(P<0.05)。同心腔两径线乘积(RL×AP),与a、b组对照,c组左心房与左心室减小(P<0.05),右心房与右心室增大(P<0.05)。左室角c组与a组对比,明显减小(88.97±5.47vs97.91±7.66,P<0.001),b组与c组间无明显差异(P>0.05)。随访发现急性肺栓塞治疗缓解后,右心室RL×AP明显缩小(4209.57±844.63vs5090.58±1312.69,P=0.002),两室左右径比值(RV/LV)明显减小(0.80±0.13vs0.93±0.19,P=0.003)。结论APE患者各心腔大小、形态随着肺动脉栓塞指数不同,而发生相应变化,并可以利用胸部CT进行初步观测及评估疗效。

Objective To measure and analyze cardiac ventricular sizes of acute pulmonary embolism patients,and compared with normal group,to investigate the morphological changes of heart in patients with acute pulmonary embolism.Methods75 patients with acute pulmonary embolism were analyzed retrospectively and were divided into two groups according to the score of embolism index:more than or equal to 50%(group c,33 cases)and less than 50%(group b,42cases)and compared with normal group(group a,56 cases)to analyze the changes of cardiac ventricular transversal diameter(LR)and anteroposterior diameter(AP).ResultsThe group c compared with group a and b,the right ventricular LR and AP,and the right atrium LR increased significantly(P<0.05),the left ventricular LR decreased significantly(P<0.05).The group b compared with the group a,the right ventricular LR and the right atrium AP increased significantly(P<0.05),the left atrium LR decreased significantly(P<0.05).The left atrial AP,group b was larger than that of group a and group c(P<0.05).The left ventricular AP,there was no significant difference between the three groups.The atrial ratio(RA/LA)and the ventricle ratio(RV/LV)of the three groups were significantly different(P<0.05).According to the product of two lines of the same heart cavity(RL×AP),compared with group a and b,the left atrium and ventricle of group c decreased(P<0.05),the right atrium and ventricle enlarged(P<0.05).Compared with group a,the left ventricular angle of group c decreased significantly(88.97±5.47 vs 97.91±7.66,P<0.001),there was no significant difference between the group b and c(P>0.05).After the treatment of acute pulmonary embolism,the right ventricular RL×AP is significantly reduced(4 209.57±844.63 vs 5 090.58±1312.69,P=0.002),the ventricle ratio(RV/LV)is significantly reduced(0.80±0.13 vs 0.93±0.19,P=0.003.ConclusionsThe size and shape of heart cavity varied with different pulmonary embolism index,and we can make preliminary observation and evaluate treatment efficacy by using chest CT scan.