急诊床旁超声心动图在急性肺栓塞诊断中的应用  

Application of emergency bedside echocardiography in early diagnosis of acute pulmonary embolism

作　　者：倪显达[1] 谢于鹏[2] 卢中秋[3] 胡元平[1] 徐湘挺[1] 

机构地区：[1]温州医学院第一附属医院超声影像科,浙江温州325000 [2]温州医学院第一附属医院呼吸内科,浙江温州325000 [3]温州医学院第一附属医院急诊科,浙江温州325000

出　　处：《温州医学院学报》2004年第4期277-279,共3页Journal of Wenzhou Medical College

摘　　要：目的 :探讨急诊床旁超声心动图在急性肺栓塞早期诊断中的应用价值。方法 :13例经螺旋CT肺动脉造影和 (或 )核素肺灌注 /通气扫描确诊的急性肺栓塞 ,采用急诊床旁超声心动图检查 ,观察右房、右室 ,肺动脉主干及分叉处有无血栓回声 ,测量右房室大小 ,肺动脉的内径 ,三尖瓣的返流 ,及估测肺动脉收缩压。总结急性肺栓塞超声心动图表现特点。结果 :超声表现有 :①右房、右室扩大。②肺动脉主干及分支扩张。③右室壁活动减弱。④继发性三尖瓣返流 ,肺动脉压力升高 ;1例于主肺动脉分叉探及血栓回声。结论 :急诊床旁超声心动图通过发现右房室、肺动脉主干或分支内的血栓回声等直接征象及右心负荷增加、右室壁活动减弱、肺动脉压力升高等间接征象对急性肺栓塞患者予以明确诊断或疑似诊断 ,可以为急性肺栓塞的临床诊断及鉴别诊断提供可靠、客观的依据。Objective:To explore the applied value of emergency bedside echocardiography in early diagnosis of acute pulmonary embolism.Methods:13 cases of hemodynamically unstable patients with a clinical suspicion of pulmonary embolism were performed by emergency bedside echocardiography and were testified by spiral computer tomography pulmonary angiography(CTPA) or ventilation-perfusion scintigraphy to observe the echo of the thrombosis in the right atrium,ventriculus,the main trunk and its bifuration of the pulmonary artery,to measure the dimension of the right atrium and ventriculus,the internal diameter of the pulmonary artery,the regurgitation of the tricuspid valveand evaluate the systolic pressure of the pulmonary artery.The manifested characteristics of the echocardiography in the patient of acute pulmonary embolism were summarized.Results:The echocardiography documented that:①Dilation of the right atrium and ventriculus.②Dilation of the main trunk and its branches of the pulmonary artery.③Decrease of the movement of the right ventricular wall.④Secondary regurgitation of the tricuspid valve and elevation of the pressure of the pulmonary artery.Echo of thrombosis at the bifurcation of the aorta was detected in one patient.Conclusion:Emergency bedside echocardiography can provide direct signs,such as the echo of the thrombosis in right atrium and ventriculus,and the main trunk and its branches of the pulmonary artery,and the indirect signs,such an overload of the right heart,decreasing of the movement of the right ventricular wall and elevation of the pressure of the pulmonary artery,of the definite and suspicious diagnosis for acute pulmonary embolism.It can also provide reliable and objective basis for the clinical diagnosis and differential diagnosis of the acute pulmonary embolism.

关 键 词：超声心动图描记术 床旁 急诊 肺栓塞 

分 类 号：R540.4[医药卫生—心血管疾病] R563.5[医药卫生—内科学]