超声心动图评估急性肺栓塞患者右心功能及疗效的临床意义

Clinical significance of ECG for evaluation of right heart function and therapeutic effect in patients with acute pulmonary embolism

目的:探讨超声心动图评估急性肺栓塞患者右心功能及疗效的临床意义。方法:选择急性肺栓塞患者63例作为肺栓塞组;另选择健康体检者60例作为健康对照组。肺栓塞组患者根据超声心动图结果分为心功能正常组(24例)和心功能异常组(39例),且均进行溶栓抗凝治疗。比较两组及肺栓塞溶栓抗凝治疗前后右心功能指标变化,及肺栓塞心功能异常和正常组患者48h内肺栓塞恶化事件及死亡情况。结果:与健康对照组比较,肺栓塞组右室射血分数(RVEF)[(65.47±5.32)%比(42.13±4.20)%]显著降低,右室舒张末容积(RVEDV)[(57.38±6.57)ml比(98.92±8.79)ml]和右室收缩末容积(RVESV)[(24.52±5.18)ml比(60.19±8.25)ml]均显著增加(P均=0.001)。与溶栓抗凝治疗前比较,肺栓塞组治疗后RVEF[(42.13±4.20)%比(56.38±7.19)%]显著提高,RVEDV[(98.92±8.79)ml比(73.24±6.57)ml]和RVESV[(60.19±8.25)ml比(38.91±6.87)ml]显著减小(P均=0.001)。与肺栓塞心功能正常组比较,心功能异常组肺动脉高压(20.83%比64.10%)、心源性休克(4.17%比30.77%)发生率及死亡率(4.17%比28.21%)显著升高(P<0.05或<0.01)。结论:超声心动图可用于急性肺栓塞患者右心功能评价,通过溶栓抗凝治疗后,右心功能显著改善。

Objective:To explore clinical significance of echocardiography(ECG)for evaluation of right heart function and therapeutic effect in patients with acute pulmonary embolism(APE).Methods:A total of 63 APE patients were treated as PE group,another 60 healthy subjects undergoing physical examination were treated as healthy control group.According to ECG results,APE group was divided into normal heart function group(n=24)and abnormal heart function group(n=39),and both groups received thrombolysis and anticoagulation treatment.Right heart function indexes were compared between two groups and between before and after treatment,incidence of PE aggravation events and death within 48h were compared between normal and abnormal heart function group.Results:Compared with healthy control group,there was significant reduction in right ventricular ejection fraction(RVEF)[(65.47±5.32)%vs.(42.13±4.20)%],and significant rise in right ventricular end-diastolic volume(RVEDV)[(57.38±6.57)ml vs.(98.92±8.79)ml]and right ventricular end-systolic volume(RVESV)[(24.52±5.18)ml vs.(60.19±8.25)ml]in PE group,P=0.001 all.Compared with before thrombolysis and anticoagulation treatment,after treatment,there was significant rise in RVEF[(42.13±4.20)%vs.(56.38±7.19)%],and significant reductions in RVEDV[(98.92±8.79)ml vs.(73.24±6.57)ml]and RVESV[(60.19±8.25)ml vs.(38.91±6.87)ml]in PE group,P=0.001 all.Compared with normal heart function PE group,there were significant rise in incidence rates of pulmonary artery hypertension(20.83%vs.64.10%),cardiogenic shock(4.17%vs.30.77%)and mortality(4.17%vs.28.21%)in abnormal heart function group,P<0.05 or<0.01.Conclusion:Echocardiography can be used for right heart function evaluation in APE patients.After thrombolysis and anticoagulation,right heart function significantly improves.