两种肺动脉压测量方法在急性中高危肺栓塞介入治疗中的临床价值对比研究

Echocardiography versus pulmonary artery catheterization for measuring pulmonary artery pressure in interventional treatment of acute mid-to-high-risk pulmonary thromboembolism:comparison of clinical value

目的比较超声心动图与肺动脉导管测量肺动脉收缩压(PASP)在急性中高危肺血栓栓塞症(PTE)血管内介入治疗中的临床价值。方法回顾性分析2017年6月至2020年2月滨州市人民医院收治的31例急性PTE患者临床资料。其中中危21例,高危10例,均伴有下肢不同部位深静脉血栓形成。所有患者介入术前均接受经胸超声心动图和DSA下肺动脉导管直接测量PASP,并序贯接受临时腔静脉滤器置入、肺动脉吸栓及导管接触溶栓,回收滤器时肺动脉导管复测PASP,次日或出院前超声心动图复测PASP。采用Pearson线性相关分析描述超声心动图与肺动脉导管测量PASP值间相关性,配对t检验比较介入术前后两者测得PASP值变化。结果31例患者介入术后肺栓塞症状均消失,25例血栓完全清除,6例大部分清除。平均溶栓时间(4.65±1.17)d,平均住院时间(10.55±1.89)d。治疗期间1例患者牙龈出血,未发生其他严重并发症。超声心动图测量与肺动脉导管实时直接测量PASP间具有显著相关性(术前r=0.99,P<0.05;术后r=0.67,P<0.05)。超声心动图、肺动脉导管测得介入术前后PASP值差异均有统计学意义(t=9.79,P<0.05;t=11.64,P<0.05)。术前肺动脉导管测压值高于超声心动图(t=5.34,P<0.05),术后测压值低于超声心电图组(t=4.21,P<0.05)。结论介入治疗急性PTE患者效果显著。超声心动图与导管测量PASP值虽略有偏差,但有显著相关性。超声心动图无创测量PASP,可为介入治疗效果评估、预后分析、随访观察提供重要临床依据。

Objective To compare the clinical value of echocardiography with that of pulmonary artery catheterization for measuring pulmonary artery systolic pressure(PASP)in interventional treatment of acute mid-to-high-risk pulmonary thromboembolism(PTE).Methods The clinical data of 31 patients with acute PTE,who were admitted to the Binzhou People’s Hospital of China between June 2017 and February 2020,were retrospectively analyzed.Of the 31 patients,21 were acute mid-risk PTE and 10 were acute high-risk PTE.Deep venous thrombosis at different sites of lower limbs was observed in all 31 patients.Transthoracic echocardiography and pulmonary artery catheterization to directly measure PASP were performed in all patients before operation.The patients received temporary implantation of inferior vena cava filter,which was followed by pulmonary artery aspiration thrombectomy and catheter-direct thrombolysis.Pulmonary artery catheterization measurement of PASP was again performed when inferior vena cava filter was removed,and transthoracic echocardiography to measure PASP was again carried out on the next day or on the disch arge day.Pearson linear correlation analysis was used to evaluate the correlation between echocardiography and pulmonary artery catheterization in measuring PASP.Paired t-test was used to compare the preoperative and postoperative PASP values.Results After interventional therapy,the symptoms of PTE disappeared in all 31 patients,the thrombus were completely cleared away in 25 patients,the thrombus were mostly removed in 6 patients.The average time for thrombolysis was(4.65±1.17)days,and the average hospitalization time was(10.55±1.89)days.During the course of treatment,one patient developed gingival bleeding and no severe complications occurred.A significant correlation existed between echocardiography and pulmonary artery catheterization in measuring PASP(before treatment r=0.99,P<0.05;after treatment r=0.67,P<0.05),The difference between preoperative PASP value and postoperative one in echocardiography group(t=9.79,P<0.05)and in catheterization group(t=11.64,P<0.05)was statistically significant.Before treatment the PASP value measured by pulmonary artery catheterization was higher than that measured by echocardiography(t=5.34,P<0.05),while after treatment the PASP value measured by pulmonary artery catheterization was lower than that measured by echocardiography(t=4.21,P<0.05).Conclusion Interventional therapy has excellent curative effect for patients with acute PTE.In measuring PASP,the value measured by echocardiography is well correlated with the value measured by pulmonary artery catheterization,although slight difference in the obtained value exists between the two methods.As echocardiography is a non-invasive technique,it should be adopted to evaluate the curative effect,prognostic analysis and follow-up check-ups.(J Intervent Radiol,2021,30:657-661)