CT肺血管成像对急性大面积肺栓塞患者的动态分析价值

目的 探讨CT肺血管成像(CTPA)对大面积肺栓塞患者的动脉栓塞程度及右心功能的动态分析价值.方法 回顾性分析23例大面积肺栓塞患者的CTPA资料,分析治疗前、治疗后24 h及14 d时的CTPA肺动脉栓塞指数及右心功能参数,采用单因素方差分析、LSD检验和X2检验分析治疗前后的变化,并采用Pearson法分析肺动脉栓寨指数与右心功能参数之间的相关性.结果 CTPA肺动脉栓塞指数在溶栓治疗后逐渐减小,Qanadli和Mastora评分在治疗前(分别为50.0、46.5分)与治疗后24 h(分别为42.5、12.1分)比较差异有统计学意义(t值分别为2.830、6.493,P值均<0.01);治疗后24 h与治疗后14 d(分别为25.0、8.4分)比较差异有统计学意义(t值分别为4.640、4.299,P值均<0.01).治疗后24 h,右心室最大短轴直径(4.58 cm)及横截面积(23.10 cm2)明显减小,左心室最大短轴直径(4.41 cm)及横截面积(26.37 cm2)明显增大,双侧心室最大直径比(1.07)和面积比(0.94)明显减小,与上述各指标治疗前相比(分别为5.07 cm、25.42 cm2、3.57 cm、20.17 cm2、1.59,1.38)差异有统计学意义(t=2.081～4.959,P值均<0.05);治疗后24 h,肺动脉收缩压(40.92 mm Hg)明显变小,与治疗前(58.61 mm Hg)相比差异有统计学意义(t=2.824,P<0.01);治疗前与治疗后24 h,CTPA肺动脉栓塞指数与右心功能参数间均有不同程度的相关性(r=0.034～0.598,P值均<0.01).结论 CTPA可以动态观察急性肺栓塞的肺动脉阻塞程度及右心功能的变化,为临床治疗提供重要的信息.

The dynamic study of the massive pulmonary embolism on CT pulmonary angiography

Objective To dynamically evaluate the pulmonary artery obstruction index and the right ventricular function of the massive pulmonary embolism on CT pulmonary angiography (CTPA). Methods Twenty-three cases of massive pulmonary embolism were analyzed retrospectively. The pulmonary artery obstruction index (PAOI) and the right ventricular function parameters were collected and analyzed on CTPA before thrombolytic therapy, 24 hours and 14 days after therapy respectively. Student's ANOVA and LSD test was used to analyze the change of PAOI and quantification parameters of right ventricular function parameters. The right ventricular quantification parameters were analyzed by Chi-square test. Pearson correlation analysis was used to study the correlation of PAOI and right ventricular function. Results The PAOI decreased gradually after thrombolytic therapy. There was significant difference in Qanadli and Mastora scores between before (Qanadli score 50. 0,Mastora score 46. 5) and 24 hours (42. 5/12. 1) after therapy(t =2. 830,6. 493 ,P < 0. 01). The same significant difference also appeared between 24 hours and 14 days(Qanadli score 25.0,Mastora score 8.4) after therapy (t = 4. 640, 4. 299,P <0. 01). Twenty-four hoursafter therapy, the maximal minor diameter (RVd, 4. 58 cm) and maximal area (RVs 23. 10 cm2) of rightventricle decreased, the maximal minor diameter(LVd, 4. 41 cm) and maximal area (LV<,s>, 26. 37 cm2) ofleft ventricle increased, the RVd/LVd (1.07) and RVs/LVs (0. 94) decreased apparently. The aboveparameters were significantly different (t = 2. 081-4. 959, P < 0. 05) compared with which before therapy (5.07 cm, 25.42 cm2, 3.57 cm, 20. 17 cm2, 1.59, 1.38 respectively). The pulmonary artery symbolicpressure decreased from 58. 61 mm Hg before therapy to 40. 92 mm Hg 24 hours after therapy significantly(t = 2. 824, P < 0. 01). There was correlation to different degree between the PAOI and the right ventricularfunction parameters before therapy and 24 hours after therapy(r = 0. 034-0. 598, P < 0. 01). ConclusionCTPA can evaluate the pulmonary artery obstruction degree and right ventricular function after pulmonaryembolism dynamically.