CT肺栓塞指数联合右心功能参数对急性肺栓塞严重程度评价临床研究  

Clinical study of CT pulmonary embolism index combined with right ventricular function parameters on the evaluation of the severity of acute pulmonary embolism

作　　者：周磊[1] 陈成水[2] 

机构地区：[1]温州医科大学附属舟山医院呼吸科,舟山316000 [2]温州医科大学附属第一医院呼吸科,温州325000

出　　处：《新医学》2015年第1期53-57,共5页Journal of New Medicine

摘　　要：目的探讨CT肺栓塞指数(PAOI)联合右心功能参数检测对急性肺栓塞(APE)患者肺栓塞严重程度的临床意义。方法经64层CT肺动脉成像(CTPA)确诊APE患者43例,依据PAOI分为重度(4例)、中度(9例)和轻度组(30例),并设立同期CTPA阴性患者25例为对照组,测定4组在CT上的右心室短轴最大直径(RVd)、左心室短轴最大直径(LVd),计算两者之比RVd/LVd,同时检测脑钠肽、肌钙蛋白I(c Tn I)及Pa O2,比较组间的差异。结果与对照组比较,APE患者RVd、RVd/LVd、脑钠肽和c Tn I显著升高,LVd、Pa O2有下降,APE患者随着PAOI分组级别升高LVd逐渐减小,RVd、RVd/LVd逐渐增大,脑钠肽、c Tn I呈逐渐升高,氧合指标Pa O2逐渐降低,且差异有统计学意义(P<0.05)。结论 PAOI联合右心功能对APE患者肺栓塞严重程度进行评价,有利于量化判定肺栓塞的严重程度,指导危险分级、临床合理治疗及预后评估。Objective To explore the clinical significance of pulmonary artery obstruction index （PAOI）combined with right ventricular function parameters in evaluating the severity of acute pulmonary embolism （APE）.Methods Forty-three APE patients diagnosed with 64-slice spiral CT pulmonary angiography （CTPA）in our hospital were divided into the mild （n =30）,moderate （n =9）and severe groups （n =4）ac-cording to PAOI,and 25 cases with negative CTPA were recruited into the control group.The maximum diameter of short axis of the right ventricular （RVd）,maximum diameter of short axis of the left ventricular （LVd）, and the ratio of the maximum diameter of short axis of the right and left ventricular （RVd /LVd）were measured and calculated on CT images in the four groups.The brain natriuretic peptide （BNP）,cardiac troponin I （cTnI）and PaO2 were statistically compared among different groups.Results Compared with the control group, the RVd,RVd /LVd,BNP and cTnI in APE patients were significantly increased whereas LVd and PaO2 were significantly decreased.LVd gradually decreased whereas RVd and RVd /LVd steadily increased among the mild,moderate and severe groups with a statistical significance （P 〈0.05 ）.BNP and cTnI were elevated gradually whereas PaO2 was steadily reduced among the three groups with a statistical significance（P 〈0.05）. Conclusions PAOI combined with right ventricular function parameters is effective in evaluating the severity of APE by quantitatively assessing the severity of APE,risk classification,clinical treatment and prognosis.

关 键 词：急性肺栓塞 CT肺栓塞指数 右心功能 脑钠肽 肌钙蛋白I 

分 类 号：R563.5[医药卫生—呼吸系统]