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目的:评价超声心动图对急性肺动脉血栓栓塞症(PTE)患者不同治疗方法治疗前后右心功能检测意义,探讨血栓栓塞面积对治疗的影响。方法:502例急性FIE患者,根据血栓栓塞面积分为溶栓组224例,其中大面积FIE 54例和次大面积PTE170例,抗凝组278例为非大面积FIE者。治疗前后超声心动图检测右心指标:右与左心室前后径比值(RVD／LVD)、右心室横径(RVTD)、右与左心室横径比值(RVTD／LNTD)、右与左心房横径比值(RATD／LATD)、右心房横径(RATD)、左心房横径(LATD)、右心室前壁厚度(RVAWT)、右心室壁运动幅度(RVAWM)、主肺动脉内径(PA)、三尖瓣反流压差(TRPG)、下腔静脉深吸气最小径(IVC min)。结果:右心功能变化:治疗前,RVD／LVD、RVAWM、RVTD、RVTD／LVTD、RATD／LATD、PA、TRPG指标溶栓组中次大面积者与大面积者、抗凝组(非大面积者)与大面积者比较,均有显著性差异(P<0．05)。抗凝组(非大面积者)与溶栓组中次大面积者比较(除外LATD、RVAWT、IVC min),均有显著差异性(P<0．05)。溶栓组治疗前后比较RVD／LVD、RVTD、RVTD／LVTD、LATD、RATD／LATD、RVAWM、PA及TRPG指标均有显著性差异(P<0．05)。抗凝组治疗前后比较RVD／LVD、RATD／LATD及TRPG指标有显著性差异(P<0．05)。结论:超声心动图检测右心功能指标是区分PTE血流动力学变化和帮助诊断分型及观察不同治疗方法疗效的敏感指标。提示超声心动图评价急性PTE右心功能有重要意义。
Objective: To evaluate the significance of echocardiography in detecting right heart function before and after treatment of patients with acute pulmonary thromboembolism (PTE) by different treatment methods and to explore the influence of thromboembolism area on the treatment. Methods: One hundred and fifty-two patients with acute FIE were divided into thrombolytic group (n = 224) according to thromboembolism area, including 54 cases of large area FIE and 170 cases of sub-large area PTE and 278 cases of non-large area FIE in anticoagulation group. Right and left ventricular anterior-to-posterior diameter ratio (RVD / LVD), right ventricular diastolic dimension (RVTD), right ventricular systolic diameter ratio (RVTD / LNTD), right and left atrial diameter RATD, RATD, LATD, RVAWT, RVAWM, PA, Tricuspid (TRPG), IVC min. (IVC min). Results: Right ventricular function changes: Before treatment, the area of large area and large area of RVD / LVD, RVAWM, RVTD, RVTD / LVTD, RATD / LATD, PA and TRPG in thrombolytic group, ) And large area were significantly different (P <0.05). There was significant difference (P <0.05) between anticoagulation group (non-large area) and second largest area in thrombolytic group (except LATD, RVAWT and IVC min). There were significant differences in RVD / LVD, RVTD, RVTD / LVTD, LATD, RATD / LATD, RVAWM, PA and TRPG before and after thrombolytic therapy (P <0.05). RVD / LVD, RATD / LATD and TRPG were significantly different between before and after anticoagulation (P <0.05). Conclusion: The echocardiographic detection of right heart function index is a sensitive index to distinguish the hemodynamic changes of PTE and help to diagnose the type and observe the curative effect of different treatment methods. Tip echocardiography evaluation of acute right heart function PTE is important.