肺栓塞的超声心动图表现:与螺旋CT对照观察  

Echocardiographic characteristics of pulmonary embolism:comparative observation with spiral CT

作　　者：钟兴[1] 徐宏贵[1] 史长征[2] 李恒国[2] 

机构地区：[1]暨南大学附属第一医院超声科,广东广州510630 [2]暨南大学附属第一医院影像中心,广东广州510630

出　　处：《中国医学影像技术》2009年第4期635-638,共4页Chinese Journal of Medical Imaging Technology

基　　金：广东省医学科研基金(A2007343)

摘　　要：目的观察肺栓塞(PE)的超声心动图表现及其临床价值。方法收集经临床综合检查确诊的PE患者20例,将超声心动图与CT检查进行对照分析。结果20例PE中,CT显示9例肺动脉一级分支内有血栓,11例肺动脉2级及以下分支出现血栓,超声仅发现肺动脉一级分支血栓1例。在超声检查中,11例单侧PE中有2例,9例双侧PE中有7例同时出现右心室(RV)和右心房(RA)增大、右心室与左心室比值(RV/LV)增加、肺动脉(PA)扩张、肺动脉收缩压(PASP)≥40mmHg的征象;1例单侧PE和6例双侧PE出现"D"型征(P均<0.05)。9例单支PE中有1例、11例多支PE中有8例同时出现RV和RA增大、RV/LV增加、PA扩张、PASP≥40mmHg;单支PE无"D"型征,多支PE中7例出现"D"型征(P均<0.05)。结论超声心动图对左、右肺动脉内血栓的检出率低;双侧PE及多支PE超声心动图多出现急性右心压力负荷过重的表现,可提示PE;单支PE患者的右心功能可以轻度异常或正常,超声心动图难以诊断。Objective To understand echocardiographic characteristics of pulmonary embolism （PE） and their clinical sig nificances. Methods Twenty clinically diagnosed patients with PE were collected and the comparative analysis between spiral CT and echocardiography were conducted. Results In 20 patients of PE, thrombosis were found in the first branch of pulmonary artery in 9 patients, and in the second and below second branches of pulmonary artery in 11 patients with CT, but only 1 was found in the first branch of pulmonary artery with echocardiograph. Dilation of right ventricular （RV） and right atrium （RA）, increased right/left ventricular end-diastolic ratio （RV/LV）, distension of pulmonary artery （PA） and pulmo nary artery systolic pressure （PASP）≥40 mmHg were found in 2 of 11 unilateral PE and 7 of 9 bilateral PE patients with echocardiography, while ＂D＂ type sign was detected in 1 unilateral and 6 bilateral PE patients （P〈0. 05）. One of 9 single branch PE and 7 of 11 multiple branches PE patients showed the dilation of RV and RA, increased RV/LV ratio, distension of PA, and PASP≥40 mmHg simultaneously. ＂D＂ type sign was found in 7 multiple branches PE patients, but none of single branch PE （P〈0.05）. Conclusion The chance of discovering thrombosis in the left or right pulmonary artery with echocardiography is low. Acute right heart overload can be found mostly in bilateral PE and multiple branches PE with echocardiography, indicating the existence of PE. Single branch PE is difficult to be diagnosed with echocardiography because the heart function of single branch PE will be mild abnormal or normal.

关 键 词：肺栓塞 超声心动描记术 体层摄影术 X线计算机 

分 类 号：R563.5[医药卫生—呼吸系统] R540.45[医药卫生—内科学]