冠状动脉计算机断层摄影术对疑似肺栓塞的诊断价值  

Diagnostic Value of CT Coronary Angiography on Pulmonary Embolism in Suspicious PE Patients

作　　者：杨遇春[1] 鲁锦国[1] 尚健慧 陈鑫[2] 陈燕[2] 刘会霖[1] 苏晞[1] 

机构地区：[1]武汉亚洲心脏病医院心内科,湖北省武汉市430000 [2]武汉亚洲心脏病医院放射科,湖北省武汉市430000

出　　处：《中国循环杂志》2016年第4期337-340,共4页Chinese Circulation Journal

摘　　要：目的:研究心内科疑似肺栓塞患者的临床及血栓分布特点,探讨冠状动脉计算机断层摄影术(CTCA)扫描在诊断冠心病的同时能否同时排除肺栓塞。方法:2013-01至2014-10在我院心内科住院时疑诊肺栓塞患者,回顾性分析行64层计算机断层摄影术肺动脉造影(CTPA)患者的临床特点及CTPA上血栓分布特点。将诊断肺栓塞者设为肺栓塞组(n=261),无肺栓塞者为非肺栓塞组(n=142)。结果:403例患者中,肺栓塞患者261例(64.8%)。所有疑似肺栓塞患者主要表现为胸闷、心悸、胸痛及晕厥。肺栓塞组中,女性、心悸患者的比例高于非肺栓塞组,而胸痛的比例少于非肺栓塞组,差异均有统计学意义(P<0.05);肺栓塞组晕厥、胸闷患者比例高于非肺栓塞组,但差异无统计学意义(P>0.05)。245例(93.9%)肺栓塞患者于CTCA扫描区域均能发现血栓征象,余肺栓塞患者16例(6.1%)为小面积肺栓塞,其血栓仅位于两上肺动脉。结论 :由于就诊心内科的肺栓塞患者临床表现与心血管疾病的相似性,对心内科呼吸困难、心悸、胸痛、晕厥的患者,需同时诊断有无冠心病及肺栓塞。CTCA扫描在诊断冠心病能同时基本明确诊断肺栓塞。Objective： To study clinical characteristics and anatomical distributions of pulmonary embolism（PE） in suspicious PE patients and to explore if CT coronary angiography（CTCA） may simultaneously exclude PE.Methods： A total of 403 consecutive patients with suspicious PE admitted to cardiology department of our hospital from 2013-01 to 2014-10 were retrospectively studied. According to embolus distribution by CT pulmonary angiography（CTPA） and CTCA,the patients were divided into 2 groups： PE group,n=261 and Non-PE group,n=142. The clinical symptoms and imaging characteristics were analyzed and compared between 2 groups.Results： The overall prevalence of PE was 64.8%（261/403）,suspicious PE patients were all with chest distress,palpitation,chest pain and syncope. Compared with Non-PE group,the patients in PE group were with more female gender and palpitation,while less chest pain,P0.05; the symptoms of syncope and chest distress were similar between 2 group,P0.05. In PE group,the sign of emboli were found in 245/261 patients（93.9%） at CTCA scanning area,the rest 16 patients（6.1%） had the small area of PE,and the emboli were only located at both upper pulmonary arteries.Conclusion： In patients with difficulty of breath,palpitation,chest pain and syncope,coronary artery disease（CAD） and PE should be simultaneously considered for accurate diagnosis. CTCA may meanwhile find PE during CAD diagnosis.

关 键 词：肺栓塞 冠状动脉 体层摄影术 X线计算机 

分 类 号：R54[医药卫生—心血管疾病]