超声在急性肺血栓栓塞症危险分层中的应用价值
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摘要
目的分析超声在急性肺血栓栓塞症(pulmonary thromboembolism,PTE)危险分层中的应用意义。方法回顾性分析收治的127例急性PTE患者的临床资料,按栓塞面积分为高危组24例、中危组49例、低危组54例,比较3组经胸心脏超声检测指标、心尖四腔心切面舒张末期内径(RVID)、右心室横径/左心室横径(RVTD/LVTD)、舒张末期右心室前后径/左心室前后径(RVD/LVD)、舒张期右心室壁运动幅度(RVAWM)、三尖瓣反流压差(TRPG)及下肢静脉超声检测结果。结果 3组RVID、RVTD/LVTD、RVD/LVD及TRPG比较差异有统计学意义(P <0. 05),且高危组上述指标高于中危组和低危组,中危组高于低危组(P <0. 05)。3组合并下肢深静脉血栓发生率及受累静脉比例比较差异无统计学意义(P>0. 05)。结论超声用于急性PTE危险分层具重要预测价值。
Objective To analyze value of ultrasound in application of risk stratification of patients with acute pulmonary thromboembolism( PTE). Methods Clinical data of 127 patients with acute PTE was retrospectively analyzed,and the patients were divided into high-risk group( n = 24),moderate-risk group( n = 49) and low-risk group( n = 54) according to embolization areas. Results There were statistically significant differences in values of apical four-chamber end internal dimension,RVTD/LVTD,RVAD/LVAD and TRPG among three groups( P < 0. 05),and the above values in high-risk group were significantly higher than those in moderate-risk and low-risk groups,while the above values in moderate-risk group were significantly higher than those in low-risk group( P < 0. 05). There were no significant differences in incidence rate of combined with deep vein thrombosis of lower limb and ratio of affected veins among three groups( P > 0. 05). Conclusion Ultrasound is of great value in forecasting of risk stratification of patients with acute PTE.
Objective To analyze value of ultrasound in application of risk stratification of patients with acute pulmonary thromboembolism( PTE). Methods Clinical data of 127 patients with acute PTE was retrospectively analyzed,and the patients were divided into high-risk group( n = 24),moderate-risk group( n = 49) and low-risk group( n = 54) according to embolization areas. Results There were statistically significant differences in values of apical four-chamber end internal dimension,RVTD/LVTD,RVAD/LVAD and TRPG among three groups( P < 0. 05),and the above values in high-risk group were significantly higher than those in moderate-risk and low-risk groups,while the above values in moderate-risk group were significantly higher than those in low-risk group( P < 0. 05). There were no significant differences in incidence rate of combined with deep vein thrombosis of lower limb and ratio of affected veins among three groups( P > 0. 05). Conclusion Ultrasound is of great value in forecasting of risk stratification of patients with acute PTE.
引文
[1]许晓岩,杨媛华,翟振国.凝血因子ⅩⅢ基因多态性与肺血栓栓塞症的相关性研究[J].首都医科大学学报,2013,34(1):134-139.
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[6]杜辛歌,王迎难,程燕雯,等.临床评分与D二聚体及超声显像对肺血栓栓塞症的诊断价值[J].血栓与止血学,2017,23(1):71-72.
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[8]黄婷,马淑梅.实时动态三维心脏超声评价左右心室功能的研究进展[J].中国医师进修杂志,2016,39(s1):67-70.
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[10] Konstantinides S V,Torbicki A,Agnelli G,et al. 2014ESC guidelines on the diagnosis and management of acute pulmonary embolism[J]. Eur Heart J,2014,35(43):3033-3069.
[11]梁峰,胡大一,沈珠军,等. 2014年欧洲心脏学会急性肺栓塞诊断治疗指南解读[J].中华心脏与心律电子杂志,2014,2(3):21-26.
[12]梁芳,王在义.肺动脉高压对急性肺栓塞中危险分层及预后评估的作用[J].临床肺科杂志,2015,20(2):272-275.
[13]李一丹,吕秀章,王怡丹,等.经胸超声心动图评价肺动脉高压右心结构及功能的临床研究[J].中国超声医学杂志,2015,31(9):789-791.
[14]李一丹,吕秀章,孟祥丽,等.超声二维斑点追踪技术评价肺动脉高压右心功能及血流动力学的临床研究[J].中华超声影像学杂志,2016,25(7):553-557.
[15]乌兰,石燕清,王红春,等.超声在急性肺血栓栓塞症危险分层的应用意义[J].中国实验诊断学,2016,20(8):1297-1299.
[16]王巍,王琼,郑海宁,等.彩色多普勒超声诊断下肢深静脉血栓与肺栓塞的相关性[J].临床军医杂志,2015,43(11):835-837.
[17]罗小云,张福先,张昌明,等.急性下肢深静脉血栓形成后肺栓塞严重程度的危险因素分析[J].中华外科杂志,2015,53(8):580-583.
[18]徐中强,刘佩沙.分析心脏超声与下肢深静脉超声用于肺血栓栓塞症诊断中的临床效果[J].世界中医药,2016,11(B6):1718.
[2]林莹,李彦华,郭新红,等.特殊肺血栓栓塞症抗凝治疗3例分析[J].创伤与急危重病医学,2017,5(1):54-57.
[3]梁颖,米玉红,杨庚,等.老年和非老年急性肺血栓栓塞症临床风险因素比较[J].中国医药,2015,10(10):1442-1444.
[4]代菁,詹莉.急性肺血栓栓塞症患者溶栓治疗前后的心电图变化[J].血栓与止血学,2016,22(1):21-23.
[5]孟艳红.老年急性肺血栓栓塞症严重程度与心电图评分的关系[J].血栓与止血学,2017,23(2):282-284.
[6]杜辛歌,王迎难,程燕雯,等.临床评分与D二聚体及超声显像对肺血栓栓塞症的诊断价值[J].血栓与止血学,2017,23(1):71-72.
[7]邹宝,段建明.下肢深静脉血栓各分期的彩色多普勒表现及疗效评价[J].血栓与止血学,2012,18(2):79-82.
[8]黄婷,马淑梅.实时动态三维心脏超声评价左右心室功能的研究进展[J].中国医师进修杂志,2016,39(s1):67-70.
[9]高蓓,穆玉明.超声心动图对右心室功能的评价[J].医学综述,2015,21(8):1465-1467.
[10] Konstantinides S V,Torbicki A,Agnelli G,et al. 2014ESC guidelines on the diagnosis and management of acute pulmonary embolism[J]. Eur Heart J,2014,35(43):3033-3069.
[11]梁峰,胡大一,沈珠军,等. 2014年欧洲心脏学会急性肺栓塞诊断治疗指南解读[J].中华心脏与心律电子杂志,2014,2(3):21-26.
[12]梁芳,王在义.肺动脉高压对急性肺栓塞中危险分层及预后评估的作用[J].临床肺科杂志,2015,20(2):272-275.
[13]李一丹,吕秀章,王怡丹,等.经胸超声心动图评价肺动脉高压右心结构及功能的临床研究[J].中国超声医学杂志,2015,31(9):789-791.
[14]李一丹,吕秀章,孟祥丽,等.超声二维斑点追踪技术评价肺动脉高压右心功能及血流动力学的临床研究[J].中华超声影像学杂志,2016,25(7):553-557.
[15]乌兰,石燕清,王红春,等.超声在急性肺血栓栓塞症危险分层的应用意义[J].中国实验诊断学,2016,20(8):1297-1299.
[16]王巍,王琼,郑海宁,等.彩色多普勒超声诊断下肢深静脉血栓与肺栓塞的相关性[J].临床军医杂志,2015,43(11):835-837.
[17]罗小云,张福先,张昌明,等.急性下肢深静脉血栓形成后肺栓塞严重程度的危险因素分析[J].中华外科杂志,2015,53(8):580-583.
[18]徐中强,刘佩沙.分析心脏超声与下肢深静脉超声用于肺血栓栓塞症诊断中的临床效果[J].世界中医药,2016,11(B6):1718.