超声心动图对中危及高危急性肺动脉栓塞诊断的筛选价值  

The screening value of echocardiography in the diagnosis of intermediat and high risk acute pulmonary embolism

作　　者：张艳芳 

机构地区：[1]高密市夏庄镇卫生院,山东高密261505

出　　处：《泰山医学院学报》2016年第1期54-56,共3页Journal of Taishan Medical College

摘　　要：目的以右心室扩大、肺动脉高压、左心室受压呈D型改变为线索,观察超声心动图对高危和中危急性肺动脉栓塞的筛选价值。方法回顾分析近十年来,在超声心动图检查中,发现右心室扩大、左室呈D型、肺动脉收缩压升高者144例,均完成了CT肺动脉成像检查(CTPA),作为诊断急性肺动脉栓塞的标准。根据主要诊断分组进行分析,观察超声心动图检查对中危及高危急性肺动脉栓塞的筛选价值。结果以肺动脉高压、右心室扩大、左心室呈D型为条件,诊断中或高危急性肺动脉栓塞阳性率为40.97%(59/144)。另外85例符合上述条件者,其中二尖瓣狭窄所致20例,原发性肺动脉高压所致22例,COPD肺心病所致24例,房间隔缺损19例。急性中、高危肺动脉栓塞组与原发性肺动脉高压组的鉴别主要依靠后者肺动脉压力升高的程度重和右心室壁增厚,两者差异均有统计学意义(P<0.05)。超声心动图检查可以确诊二尖瓣狭窄、房间隔缺损,结合COPD病史及体征,可以确诊COPD肺心病。结论超声心动图检查可做为线索提示中危及高危急性肺动脉栓塞,并能对二尖瓣狭窄、房间隔缺损、COPD肺心病做出鉴别诊断。Objective： To evaluate the value of screening the acute high-risk and intermediat-risk pulmonary embolism（ APE）,using echocardiography on the basis of the right ventricular enlargement,associated with pulmonary arterial hypertension（ PAH） and D-shaped left ventricle. Methods： Analyzed the 144 patients with the enlarged right ventricle,pulmonary arterial hypertension（ PAH） and D-shaped left ventricle showed by echocardiography in a decade,All patients had been finished the spiral CT pulmonary angiography（ CTPA）,as a standard diagnosis of acute pulmonary embolism. In order to evaluate the role of echocardiography,all patients were grouped on the basis of main diagnosis. Results： When the diagnosis of APE was based on the condition of pulmonary arterial hypertension（ PAH）,the right ventricular enlargement and Dshaped left ventricle,the positive rate was 40. 97%（ 59 /144）. The other 85 cases include 20 cases with mitral stenosis,22 cases with PPH and 24 cases with COPD,19 cases with ASD. The difference between the APE and PPH depends on the degree of pulmonary artery pressure and the thickness of the right ventricular wall. In the later group,the increasement of pulmonary artery pressure and the thickness of the right ventricular wall were evident significantly（ P 〈 0. 05）. The echocardiography has the diagonosis value to MS,ASD and COPD. combined with diease recording. Conclusions： Echocardiography can be used as a clues to screen the hint high-risk and the intermediate risk APE. It aiso could be used to diagnose the MS,ASD and COPD and distinguish the PPH.

关 键 词：超声心动图 右心室扩大 肺动脉高压 左心室呈D形 右心室壁厚度 肺栓塞 

分 类 号：R563.5[医药卫生—呼吸系统]