肺源性心脏病合并冠心病的诊断分析及双源CT的应用  

Diagnosis of cor pulmonale amalgamated with coronary heart disease and the application of dual source computed tomography

作　　者：宋毅[1] 李婵[1] 黄久荣[1] 王敏[1] 

机构地区：[1]四川省人民医院草堂病区内五科,四川成都610072

出　　处：《吉林医学》2012年第23期4931-4933,共3页Jilin Medical Journal

摘　　要：目的:探讨肺源性心脏病合并冠心病的特点及双源CT的诊断价值。方法:对35例肺源性心脏病合并冠心病和70例单纯肺源性心脏病患者进行临床常规诊断,收集并对合并冠心病的患者35例行心脏双源CT冠状动脉成像检查。结果:病史之高血压、冠心病家族史、高血脂、既往左心力衰竭史;症状体征的心绞痛、夜间阵发性呼吸困难、A2>P2及心力衰竭伴心界向向左扩大;各项检查的左心室大或双心室增大及主动脉弓迂曲延长钙化,心电图上持续ST-T改变、左束支阻滞、持续性房颤,颈动脉粥样硬化斑块等在肺源性心脏病合并冠心病组较单纯肺源性心脏病组间比较,差异有统计学意义(P<0.05)。35例肺源性心脏病合并冠心病经心脏双源CT冠状动脉成像确诊冠心病26例(74.29%),冠状动脉完全正常3例(8.57%),不同程度冠状动脉狭窄6例(17.14%)。结论:结合病史、临床表现、胸片、心电图、心脏超声、颈动脉彩超等综合分析可以提示肺源性心脏病合并冠心病,而无创、相对价廉的DSCT可以做出更为准确的诊断。Objective To probe the clinical characteristic of chronic cur pulmonale with coronary heart disease and the Diagnostic value of dual source computed tomography（DSCT） on.Methods To collect clinical routine diagnostic data of 35 cases of eor pulmonale with coronary heart disease（combined group） and 70 eases of simple cot pulmona/e （simple group）,and do DSCT scan on the combined group.Results There were significant differences between the two groups in a history of hypertension, family history of coronary heart disease, high blood lipids, history of left heart failure, signs and symptoms of angina, paroxysmal nocturnal dyspnea, A2 〉 P2 and heart failure with heart border to the left to expand, inspection of the left ventrieular large or biventrieular increase and extend the tortuosity of the aortic arch ealeilieation, a ECG, changes of continuous ST- T changes, left bundle branch block, persistent atrial fibrillation, carotid atheroselerotie plaque and so on（ P 〈 0.05 ）. 35 eases of eor pulmonale with coronary artery disease by cardiac dual- source CT coronary angiography diagnosed coronary heart disease in 26 eases （74.29%） ,while completely normal coronary artery in 3 eases （8.57%） ,different degrees of coronary stenosis in 6 cases （ 17.14% ）. Conclusion Combined with comprehensive analysis of the history, clinical presentation, chest radiograph, electrocardiogram, eehocardiography： carotid ultrasonography, etc. can prompt cur pulmonale with coronary heart disease, but DSCT with non - invasive, relatively inexpensive eharaclenstics can make more accurate diagnosis.

关 键 词：肺源性心脏病 冠心病 诊断 双源CT 

分 类 号：R541.5[医药卫生—心血管疾病]