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目的探讨超声在诊断急性肺栓塞(PTE)及其对溶栓后疗效的评价。方法临床疑似PTE的35例患者进行超声心动图和下肢深静脉超声检查。经临床表现、心电图、超声、核素、螺旋CT、肺动脉造影综合检查后确诊的较大面积肺栓塞的25例接受溶栓抗凝治疗。比较溶栓前、溶栓后2周、溶栓后3个月心脏及下肢深静脉血栓的变化情况。结果超声心动图诊断PTE的直接征象(肺动脉血栓)2例,间接征象23例,无异常变化10例。溶栓后2周超声相关的主要监测指标(右室舒张末前后径RVEDD,右房舒张末上下径RADD,肺动脉主干内径MPA,肺动脉血流峰值速度VPA,肺动脉血流加速时间AT,三尖瓣反流峰值速度Vp,肺动脉收缩压PASP)与溶栓前参数比较明显好转(P<0.05),具有统计学意义。3个月后有8例超声的各项指标正常,其余与溶栓后2周的参数值比较无统计学差异。下肢深静脉检查18例32条血管内血栓。溶栓治疗后12例有效,管腔大部分再通,6例无效。结论超声诊断急性肺栓塞安全、无创、可靠,并且可作为溶栓疗效评价和长期随诊的工具。
Objective To evaluate the value of ultrasound in the diagnosis of acute pulmonary embolism (PTE) and its effect on thrombolysis. Methods Thirty-five patients with clinically suspected PTE underwent echocardiography and deep venous ultrasonography. The clinical manifestations, electrocardiogram, ultrasound, radionuclides, spiral CT, pulmonary angiography confirmed the diagnosis of larger area of pulmonary embolism in 25 patients undergoing thrombolysis anticoagulant therapy. Before thrombolysis, 2 weeks after thrombolysis, 3 months after thrombolysis, heart and lower extremity deep venous thrombosis changes. Results Echocardiography was used to diagnose the direct signs of PTE (pulmonary thromboembolism) in 2 cases and indirect signs in 23 cases with no abnormal changes in 10 cases. Two weeks after thrombolytic therapy, the main monitoring indexes (right ventricular diastolic anteroposterior diameter RVEDD, right atrial diastolic diameter RADD, pulmonary arterial diameter MPA, pulmonary artery peak velocity VPA, pulmonary artery velocity AT, tricuspid valve Vp, PASP) and parameters before thrombolysis were significantly improved (P <0.05), with statistical significance. Three months later, there were 8 cases of ultrasound in all the indicators of normal, and the remaining 2 weeks after thrombolysis parameters were no significant difference. Lower extremity deep vein examination of 18 cases of 32 intravascular thrombosis. Twelve cases were effective after thrombolytic therapy, most of the lumen was recanalized, and 6 cases were ineffective. Conclusion Ultrasound diagnosis of acute pulmonary embolism safe, noninvasive, reliable, and can be used as a diagnostic evaluation of thrombolytic therapy and long-term follow-up tools.