128层螺旋CT肺动脉造影对急性肺栓塞患者栓塞程度和右心功能的评估价值研究
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摘要
目的:探讨128层螺旋CT肺动脉造影(CTPA)对急性肺栓塞(APE)患者栓塞程度和右心功能的评估价值。方法:选取2016年7月到2018年6月期间在我院行CTPA检查确诊并接受治疗的APE患者100例记为观察组,根据观察组患者的病情将其分为高危组(57例)和非高危组(43例),同时根据观察组患者肺栓塞部位及预后将患者分为中心肺栓塞死亡组(8例)、中心肺栓塞存活组(38例)、周围肺栓塞组(54例)。另选择同期于我院进行CTPA检查的无肺栓塞患者50例记为对照组。记录所有患者的右心功能参数[右心室短轴最大径(RVMSA)、左心室短轴最大径(LVMSA)以及二者的比值(RV:LV)],计算APE患者的CT肺动脉阻塞指数,并分析APE患者CT肺动脉阻塞指数与右心功能指标的相关性。结果:观察组的RVMSA、RV:LV均明显高于对照组(P<0.05),高危组的CT肺动脉阻塞指数、RVMSA、RV:LV均明显高于非高危组(P<0.05)。中心肺栓塞死亡组的CT肺动脉阻塞指数、RVMSA、RV:LV均明显高于中心肺栓塞存活组和周围肺栓塞组,中心肺栓塞存活组的CT肺动脉阻塞指数、RVMSA、RV:LV均明显高于周围肺栓塞组(P<0.05)。经Pearson相关分析显示,APE患者CT肺动脉阻塞指数与RVMSA、RV:LV均呈正相关(P<0.05),与LVMSA无明显的相关性(P>0.05)。结论:CTPA检查可有效评估APE患者的栓塞程度和右心功能,且栓塞程度与右心功能存在相关性,CTPA检查有助于APE患者的诊断和病情评估。
Objective: To explore the value of 128-slice spiral CT pulmonary angiography(CTPA) in evaluating the degree of embolism and right ventricular function in patients with acute pulmonary embolism(APE). Methods: A total of 100 patients with APE, who were diagnosed and treated by CTPA in the First People's Hospital of Ziyang from July 2016 to June 2018, were chosen as observation group. According to the patient's condition, they were divided into high-risk group(57 cases) and non-high-risk group(43 cases). At the same time, according to the location and prognosis of pulmonary embolism, the patients in the observation group were divided into three groups: central pulmonary embolism death group(8 cases), central pulmonary embolism survival group(38 cases) and peripheral pulmonary embolism group(54 cases). Another 50 patients without pulmonary embolism, who underwent CTPA examination in the hospital during the same period, were chosen as control group. The right ventricular function parameters [maximum diameter of right ventricular short axis(RVMSA), maximum diameter of left ventricular short axis(LVMSA) and their ratios(RV: LV)] were recorded in all patients.And CT pulmonary occlusion index in the patients with APE was calculated. The correlation between CT pulmonary artery occlusion index and right ventricular function index in APE patients was analyzed. Results: The RVMSA and RV: LV in the observation group were significantly higher than those in the control group(P<0.05). The CT pulmonary artery occlusion index, RVMSA and RV: LV in high-risk group were significantly higher than those in non-high-risk group(P<0.05). The CT pulmonary artery occlusion index, RVMSA and RV: LV in the central pulmonary embolism death group were significantly higher than those in the central pulmonary embolism survival group and peripheral pulmonary embolism group. The CT pulmonary artery obstruction index, RVMSA and RV: LV in the central pulmonary embolism survival group were significantly higher than those in peripheral pulmonary embolism group(P<0.05). Pearson analysis showed that CT pulmonary artery obstruction index was positively correlated with RVMSA and RV: LV in APE patients(P<0.05),but no obvious correlation with LVMSA(P>0.05). Conclusion: CTPA examination can effectively evaluate the degree of embolism and right heart function in APE patients, and the degree of embolism is correlated with right heart function. CTPA examination is helpful in diagnosing and evaluating APE patients.
Objective: To explore the value of 128-slice spiral CT pulmonary angiography(CTPA) in evaluating the degree of embolism and right ventricular function in patients with acute pulmonary embolism(APE). Methods: A total of 100 patients with APE, who were diagnosed and treated by CTPA in the First People's Hospital of Ziyang from July 2016 to June 2018, were chosen as observation group. According to the patient's condition, they were divided into high-risk group(57 cases) and non-high-risk group(43 cases). At the same time, according to the location and prognosis of pulmonary embolism, the patients in the observation group were divided into three groups: central pulmonary embolism death group(8 cases), central pulmonary embolism survival group(38 cases) and peripheral pulmonary embolism group(54 cases). Another 50 patients without pulmonary embolism, who underwent CTPA examination in the hospital during the same period, were chosen as control group. The right ventricular function parameters [maximum diameter of right ventricular short axis(RVMSA), maximum diameter of left ventricular short axis(LVMSA) and their ratios(RV: LV)] were recorded in all patients.And CT pulmonary occlusion index in the patients with APE was calculated. The correlation between CT pulmonary artery occlusion index and right ventricular function index in APE patients was analyzed. Results: The RVMSA and RV: LV in the observation group were significantly higher than those in the control group(P<0.05). The CT pulmonary artery occlusion index, RVMSA and RV: LV in high-risk group were significantly higher than those in non-high-risk group(P<0.05). The CT pulmonary artery occlusion index, RVMSA and RV: LV in the central pulmonary embolism death group were significantly higher than those in the central pulmonary embolism survival group and peripheral pulmonary embolism group. The CT pulmonary artery obstruction index, RVMSA and RV: LV in the central pulmonary embolism survival group were significantly higher than those in peripheral pulmonary embolism group(P<0.05). Pearson analysis showed that CT pulmonary artery obstruction index was positively correlated with RVMSA and RV: LV in APE patients(P<0.05),but no obvious correlation with LVMSA(P>0.05). Conclusion: CTPA examination can effectively evaluate the degree of embolism and right heart function in APE patients, and the degree of embolism is correlated with right heart function. CTPA examination is helpful in diagnosing and evaluating APE patients.
引文
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[21]Weidman EK,Plodkowski AJ,Halpenny DF,et al.Dual-Energy CTAngiography for Detection of Pulmonary Emboli:Incremental Benefit of Iodine Maps[J].Radiology,2018,289(2):546-553
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[24]Matsubara K,Sakuda K,Nunome H,et al.128-slice dual-source CTcoronary angiography with prospectively electrocardiography-triggered high-pitch spiral mode:radiation dose,image quality,and diagnostic acceptability[J].Acta Radiol,2016,57(1):25-32
[25]Leone MB,Giannotta M,Palazzini M,et al.A new CT-score as index of hemodynamic changes in patients with chronic thromboembolic pulmonary hypertension[J].Radiol Med,2017,122(7):495-504
[26]Yagi M,Taniguchi H,Kondoh Y,et al.CT-determined pulmonary artery to aorta ratio as a predictor of elevated pulmonary arterypressure and survival in idiopathic pulmonary fibrosis[J].Respirology,2017,22(7):1393-1399
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[28]Jariwala P,Ramesh G,Sarat Chandra K.Congenital anomalous/aberrant systemic artery to pulmonary venous fistula:closure with vascular plugs&coil embolization[J].Indian Heart J,2014,66(1):95-103
[29]Said SA,Agool A,Moons AH,et al.Incidental congenital coronary artery vascular fistulas in adults:Evaluation with adenosine-13N-ammonia PET-CT[J].World J Cardiol,2018,10(10):153-164
[30]邢媛媛,赵佳佳,曹宏伟,等.CT肺动脉阻塞指数在急性肺栓塞患者病情评估中的作用[J].山东医药,2018,58(20):50-52
[2]Zhang LY,Gao BA,Jin Z,et al.Clinical efficacy of low dose recombinant tissue-type plasminogen activator for the treatment of acute intermediate-risk pulmonary embolism[J].Saudi Med J,2018,39(11):1090-1095
[3]Wu XY,Zhuang ZQ,Zheng RQ,et al.Extracorporeal Membrane Oxygenation as Salvage Therapy for Acute Massive Pulmonary Embolism after Surgery for Tibiofibular Fractures[J].Chin Med J(Engl),2018,131(21):2611-2613
[4]王婷,王月文,寇峰军,等.急性肺栓塞患者溶栓抗凝治疗前后的心电图变化特征研究[J].现代生物医学进展,2017,17(33):6495-6497,6517
[5]Alis J,Latson LA Jr,Haramati LB,et al.Navigating the Pulmonary Perfusion Map:Dual-Energy Computed Tomography in Acute Pulmonary Embolism[J].J Comput Assist Tomogr,2018,42(6):840-849
[6]Bikdeli B,Lobo JL,Jiménez D,et al.Early Use of Echocardiography in Patients with Acute Pulmonary Embolism:Findings From the RI-ETE Registry[J].J Am Heart Assoc,2018,7(17):e009042
[7]Deng C,Wu D,Zhai Z,et al.Close concordance between pulmonary angiography and pathology in a canine model with chronic pulmonary thromboembolism and pathological mechanisms after lung ischemia reperfusion injury[J].J Thromb Thrombolysis,2016,41(4):581-591
[8]Cao Y,Yang T,Hou M,et al.Repair of Partial Anomalous Pulmonary Venous Connection:A Rare Case Evaluated by Multi-Slice Computed Tomographic Angiography[J].Heart Surg Forum,2018,21(2):E099-E100
[9]Wang L,Kang W,Zu M,et al.Application of 128-slice spiral CT combination scanning in the diagnosis of embolisms in pulmonary arteries and lower extremity veins[J].Exp Ther Med,2014,7(2):401-404
[10]Tahir H,Ahmad S,Awan MU,et al.Anomalous Origin of Left Anterior Descending Artery and Left Circumflex Artery from Right Coronary Sinus with Malignant Left Anterior Descending Artery Course:Role of Coronary CTAngiography Derived Fractional Flow Reserve in Decision Making[J].Cureus,2018,10(8):e3220
[11]Konstantinides SV.2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism[J].Eur Heart J,2014,35(45):3145-3146
[12]Tseng WT,Huang TL.Excited catatonia in a patient with fatal pulmonary embolism and a successful treatment strategy[J].BMC Psychiatry,2018,18(1):342
[13]Urbina T,BigéN,Nguyen Y,et al.Tissue perfusion alterations correlate with mortality in patients admitted to the intensive care unit for acute pulmonary embolism:An observational study[J].Medicine(Baltimore),2018,97(42):e11993
[14]Teng F,Chen YX,He XH,et al.Contribution of Quick Sequential Organ Failure Assessment Score Combined with Electrocardiography in Risk Stratification of Patients with Acute Pulmonary Embolism[J].Chin Med J(Engl),2018,131(20):2395-2401
[15]Gupta R,Fortman DD,Morgenstern DR,et al.Short-and Long-term Mortality Risk After Acute Pulmonary Embolism[J].Curr Cardiol Rep,2018,20(12):135
[16]Lozier JN,Elinoff JM,Suffredini AF,et al.Low-dose,short course alteplase treatment of submassive pulmonary embolism:a case series from the National Institutes of Health Clinical Center[J].Blood Coagul Fibrinolysis,2018,29(8):701-707
[17]Cherata DA,Donoiu I,Mirea O,et al.Right atrium floating thrombus and bilateral pulmonary embolism in a patient with pancreatic pseudocyst[J].J Cardiol Cases,2018,18(2):57-59
[18]何梅,吐尔逊纳依,唐庆.超声心动图参数与急性肺栓塞患者预后的相关性分析[J].中国急救医学,2016,36(10):935-939
[19]Elnabawi YA,Dey AK,Mehta NN.Emerging Applications of Coronary CT Angiography in Coronary Heart Disease:Getting Better with Time[J].Eur Heart J,2018,39(41):3682-3684
[20]Slawson D.Pulmonary Embolism Rule-Out Criteria Reduces the Need for CT Pulmonary Angiography in Low-Risk Patients[J].Am Fam Physician,2018,98(4):250
[21]Weidman EK,Plodkowski AJ,Halpenny DF,et al.Dual-Energy CTAngiography for Detection of Pulmonary Emboli:Incremental Benefit of Iodine Maps[J].Radiology,2018,289(2):546-553
[22]Ende-Verhaar YM,Kroft LJM,Mos ICM,et al.Accuracy and reproducibility of CT right-to-left ventricular diameter measurement in patients with acute pulmonary embolism[J].PLo S One,2017,12(11):e0188862
[23]Kumamaru KK,Hunsaker AR,Wake N,et al.The variability in prognostic values of right ventricular-to-left ventricular diameter ratios derived from different measurement methods on computed tomography pulmonary angiography:a patient outcome study[J].J Thorac Imaging,2012,27(5):331-336
[24]Matsubara K,Sakuda K,Nunome H,et al.128-slice dual-source CTcoronary angiography with prospectively electrocardiography-triggered high-pitch spiral mode:radiation dose,image quality,and diagnostic acceptability[J].Acta Radiol,2016,57(1):25-32
[25]Leone MB,Giannotta M,Palazzini M,et al.A new CT-score as index of hemodynamic changes in patients with chronic thromboembolic pulmonary hypertension[J].Radiol Med,2017,122(7):495-504
[26]Yagi M,Taniguchi H,Kondoh Y,et al.CT-determined pulmonary artery to aorta ratio as a predictor of elevated pulmonary arterypressure and survival in idiopathic pulmonary fibrosis[J].Respirology,2017,22(7):1393-1399
[27]Forte E,Monti S,Parente CA,et al.Image Quality and Dose Reduction by Dual Source Computed Tomography Coronary Angiography:Protocol Comparison[J].Dose Response,2018,16(4):1559325818805838
[28]Jariwala P,Ramesh G,Sarat Chandra K.Congenital anomalous/aberrant systemic artery to pulmonary venous fistula:closure with vascular plugs&coil embolization[J].Indian Heart J,2014,66(1):95-103
[29]Said SA,Agool A,Moons AH,et al.Incidental congenital coronary artery vascular fistulas in adults:Evaluation with adenosine-13N-ammonia PET-CT[J].World J Cardiol,2018,10(10):153-164
[30]邢媛媛,赵佳佳,曹宏伟,等.CT肺动脉阻塞指数在急性肺栓塞患者病情评估中的作用[J].山东医药,2018,58(20):50-52