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目的探讨心脏及外周血管超声检查在肺栓塞(PE)诊断中的应用价值。方法选取2012年1月—2014年6月保定市易县医院收治的PE患者78例。回顾性分析78例患者的超声心动图征象及下肢血管超声征象,比较溶栓、抗凝治疗前后患者肺动脉压及右房室瓣反流速度。结果 78例患者经超声心动图检查发现40例(51.3%)存在右心系统血栓征象(PE直接征象),其中肺动脉主干血栓20例,左右分支血栓15例,右心室活动性血栓5例;71例(91.0%)患者检测到右心功能异常(PE间接征象),其中右心室扩大65例,右心房扩大55例,右心室游离壁增厚37例,肺动脉扩张67例,右房室瓣反流60例;78例患者下肢血管超声检查发现61例(78.2%)存在下肢深静脉血栓形成;治疗后患者肺动脉压和右房室瓣反流速度与治疗前比较,差异有统计学意义(P<0.05)。结论超声心动图可通过直接或间接征象来诊断PE,且操作简单、无侵入性,结合下肢静脉超声检查可进一步明确PE诊断。
Objective To investigate the value of cardiac and peripheral vascular ultrasonography in the diagnosis of pulmonary embolism (PE). Methods From January 2012 to June 2014, 78 cases of PE patients admitted to Yixian Hospital of Baoding City were selected. A retrospective analysis of 78 patients with echocardiographic signs and lower extremity vascular ultrasound signs of thrombolysis, anticoagulant therapy before and after pulmonary artery pressure and right atrial valve regurgitation velocity. Results Seventy-eight cases (51.3%) had right heart thrombosis signs (PE direct signs) in 78 patients by echocardiography. Among them, there were 20 cases of pulmonary artery thrombosis, 15 cases of left and right branch thrombosis and 5 cases of right ventricular active thrombus; (91.0%) patients were detected right ventricular dysfunction (PE indirect signs), including 65 cases of right ventricular enlargement, 55 cases of right atrium enlargement, 37 cases of right ventricular free wall thickening, pulmonary artery dilatation in 67 cases, right atrial valve flap Flow in 60 cases; 78 cases of lower extremity vascular ultrasound found in 61 cases (78.2%) of lower extremity deep vein thrombosis; after treatment, pulmonary arterial pressure and right atrioventricular valve regurgitation velocity compared with before treatment, the difference was statistically significant (P <0.05). Conclusions Echocardiography can diagnose PE by direct or indirect signs and is easy to operate and noninvasive. Combined with venous ultrasonography of lower extremity can further confirm PE diagnosis.