肺V/Q平面及断层显像对创伤及术后肺栓塞的诊断价值  

Study on significance of planar and SPECT ventilation-perfusion(V/Q) lung scanning in diagnosis of pulmonary embolism in patients after trauma or operation

作　　者：杨芳[1,2] 王蒨[1] 

机构地区：[1]首都医科大学附属安贞医院核医学科 [2]北京积水潭医院核医学科

出　　处：《临床和实验医学杂志》2013年第6期401-403,406,共4页Journal of Clinical and Experimental Medicine

基　　金：首都临床特色应用研究基金项目(编号D101100050010034)

摘　　要：目的探讨肺通气/灌注显像(肺V/Q显像)对创伤及术后患者肺栓塞(PE)诊断的应用价值。方法对73例创伤及术后患者进行肺V/Q显像,其中36例患者在平面显像基础上进行了肺V/Q断层显像;34例患者同时行核素下肢深静脉显像。结果肺V/Q显像结合临床综合评估共诊断PE患者31例(42.5%),其中肺段性PE 19例,亚肺段及以下PE 12例。4例患者在平面显像上未发现肺段性灌注缺损,经断层显像诊断为亚肺段PE,且断层显像较平面显像发现更多亚肺段缺损。超声及核素下肢深静脉显像诊断16例患者发生下肢深静脉血栓(21.9%)。PE组与非PE组患者在年龄、性别、卧床时间、是否以骨折为基础病以及D-二聚体升高方面均无统计学差异,但PE组下肢深静脉血栓形成的患者比率明显高于非PE组,差异有统计学意义(P=0.003)。结论肺V/Q显像可作为创伤及术后患者进行PE筛查的常规手段,肺V/Q断层显像可降低不确定的PE的比率,提高亚肺段PE的检出率,从而提高诊断准确性。Objective To explore the significance of application of planar and SPECT ventilation - perfusion （V/Q） lung scanning in di- agnosis of pulmonary embolism in patients after trauma or operation. Methods Among seventy - three patients after trauma or operation underwent ventilation - perfusion （V/Q） lung scanning, thirty - six of them carried out SPECT V/Q imaging on the basis of planar scanning. Thirty - four patients simultaneously took radionuclide venography. Results Thirty - one PE patients （42.5%） were diagnosed through V/Q lung scanning combined with clinical assessment, among them nineteen patients were diagnosed as segmental PE and twelve patients as sub - segmental PE. Four patients with sub - segmental PE by SPECT V/Q imaging had no segmental perfusion defect on planar scanning. SPECT V/Q imaging could detect more sub - segmental perfusion defect than planar scanning. Sixteen patients （21.9%） had deep vein thrombosis in lower limbs. There was no statistical difference in aspect of age, gender, duration of lying in bed, fracture background and D - Dimer level between PE group and non - PE group, but the incidence of deep vein thrombosis in lower limbs in PE group was obviously higher, and their difference was statistically significant （ P = 0. 003 ）. Conclusion Ventilation - perfusion （V/Q） lung scanning should be performed as a routine method for screening pulmonary embol- ism in patients after trauma or operation. SPECT V/Q scanning can reduce the rate of missed diagnosis of PE and raise the detection rate of sub - segmental PE, thus it may improve the accuracy of diagnosis.

关 键 词：肺栓塞 创伤 术后 V Q显像 SPECT 

分 类 号：R641[医药卫生—外科学] R563.5[医药卫生—临床医学]