床旁超声评估新型冠状病毒肺炎患者静脉血栓栓塞症风险的初步探讨  

A preliminary study of bedside ultrasound in the evaluation of venous thromboembolism in patients with novel coronavirus’s pneumonia

作　　者：屈亚莉 吕朝阳 雷冰心 李硕[2] 尹莉[2] 曹文[2] 郭瑞君[2] QU Yali;LV Zhaoyang;LEI Bingxin;LI Shuo;Yin li;CAO Wen;GUO Ruijun(Department of Ultrasound Medicine,Beijing Chaoyang hospital,Beijing 100020,China)

机构地区：[1]湖北省武汉市金银潭医院超声科,430023 [2]首都医科大学附属北京朝阳医院超声医学科

出　　处：《心肺血管病杂志》2020年第7期757-761,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:初步探讨床旁危重症超声在评估新型冠状病毒肺炎(COVID-19)患者静脉血栓栓塞症风险中的应用价值。方法:按照纳入标准筛选出进行了床旁超声检查的COVID-19患者50例,记为A组,统计Caprini评分以及静脉血栓的比例;②统计截至目前筛查出下肢静脉血栓阳性的患者39例,记为B组,统计D-Dimer、hs-CRP、的情况,以及右心功能情况(包括右心房左右径、右心室基底内径、肺动脉及三尖瓣反流情况)。③初步统计131例COVID-19患者的心脏超声情况(右心房大小、肺动脉宽度、肺动脉反流情况、三尖瓣反流情况、有无心脏或肺动脉血栓等情况)。结果:A组患者Caprini的平均评分(6.1±1.3)分,A组50例患者中存在静脉血栓者37例,占74%,其中1例合并肺动脉、下腔静脉及肝静脉血栓;②B组39例患者中D-Dimer 17.6(10.7,43.9)mg/L,平均hs-CRP 473.5(76.4,536.2)ng/L、BNP 175.6(635.2,723.1)ng/L,右心房左右径(47.5±9.3)mm,右心室基底内径(46.9±7.9)mm,均明显增高;肺动脉瓣或三尖瓣反流者23例,占59%;③统计的131例患者的心脏超声情况:右心房增大者10例(7.6%),肺动脉增宽或反流25例(19.1%)、三尖瓣反流者40例(30.5%)、发现心脏及肺动脉血栓者4例(3.1%),90例患者(68.7%)出现左心室舒张功能减低。结论:COVID-19危重症者存在较高的静脉血栓栓塞的风险;②COVID-19患者右心功能减退,各参数均明显增高,且存在较高下肢静脉发生率,高度怀疑COVID-19患者存在肺栓塞的较高风险。③初步统计发现的患者出现左心室舒张功能减低,COVID-19或者药物应用与心肌损伤的相关性尚有待下一步的研究。Objective:To explore the value of bedside ultrasound in evaluating the risk of venous thromboembolism in corona virus disease 2019(COVID-19).Methods:According to the inclusion criteria,50 patients with COVID-19 who underwent bedside ultrasound examination were selected and divided into group A.The Caprini score and the proportion of venous thrombosis in group A were calculated.Up to now,39 patients with positive venous thrombosis of lower extremities were identified as group B.the D-Dimer,high sensitivity troponin BNP and right ventricular function(including left and right atrial diameter,basal diameter of right ventricle,pulmonary artery and tricuspid regurgitation)in group B were calculated.The echocardiography(size of right atrium,width of pulmonary artery,pulmonary regurgitation,tricuspid regurgitation,cardiac or pulmonary thrombosis,etc.)in 131patients with COVID-19 were analyzed.Results:The average score of Caprini in group A was(6.1±1.3).among the 50 patients in group A,venous thrombosis was found in 37 cases(74%),of which 1 case was complicated with pulmonary artery,inferior vena cava and hepatic vein thrombosis.In group B,D-Dimer was 17.6(10.7,43.9)mg/L,mean high sensitivity was troponin 473.5(76.4,536.2)ng/mL,BNP 175.6(635.2,723.1)ng/mL,right atrium diameter(47.5±9.3)mm,right ventricular basal diameter(46.9±7.9)mm,were significantly increased,pulmonary valve or tricuspid regurgitation was found in 23 cases(59%).The echocardiographic findings of 131patients were as follows:Enlargement of right atrium in 10 cases(7.6%),pulmonary artery enlargement or regurgitation in 25 cases(19.1%),tricuspid regurgitation in 40 cases(30.5%),cardiac and pulmonary thrombosis in 4 cases(3.1%),and left ventricular diastolic dysfunction in 90 cases(68.7%).Conclusions:Critically ill patients with COVID-19 have a higher risk of venous thromboembolism;In patients with COVID-19,the right ventricular function decreased,all parameters increased significantly,and there was a higher incidence of lower limb vein.It was highly suspe

关 键 词：新型冠状病毒肺炎 床旁超声 危重症超声 血栓 肺栓塞 

分 类 号：R56[医药卫生—呼吸系统]