超声心动图诊断急性肺动脉栓塞的价值

目的 :分析评价床旁超声心动图 (ECHO)在急性肺动脉栓塞 (APE)诊断中的实用价值。方法 :采用经胸ECHO对临床怀疑APE的 5 8例患者在 4～ 6h内行床旁ECHO检查。结果 :超声直接检出主肺动脉及左右肺动脉主干近端血栓者 4例 ,均被外科手术或肺动脉造影证实。本组具有典型右心负荷过重超声征象者 15例 (其中包括具有超声直接征象的 4例 ) ,核素肺灌注 通气扫描提示为双肺多发性大面积栓塞。仅右房、右室轻度增大或肺动脉轻度增宽者 19例 ,ECHO无改变者 2 4例 ,但核素肺灌注 通气扫描均提示为肺段或亚段栓塞。结论 :ECHO能够发现主肺动脉、左右肺动脉干内附壁血栓直接提示肺动脉栓塞 ,或根据右室负荷过重表现间接提示肺栓塞的可能 ,但对肺段或亚段栓塞者超声不能作出或排除诊断。

Value of echocardiographic diagnosis for acute pulmonary embolism

Objective:This article is to assess the applicated value of the bed-sided echocardiographic diagnosis for acute pulmonary embolism.Methods:58 patients who were suspected of acute pulmonary embolism by physician were detected by the bed-sided echocardiography.Result:4 cases of thromboembolism in major pulmonary artery were noted by echocardiography and were testified by surgery or pulmonary angiography,15 cases of typical right ventricular pressure overload in echocardiogram were found as multiple wide pulmonary embolism by ventilation-perfusion scintigraphy.19 cases of right atrial/ventricular or major pulmonary arterious slight dilation and 24 cases of normal echocardiogram were identified as pulmonary segmental or subsegmental embolism by scintigraphy.Conclusion:Echocardiography could directly diagnose pulmonary embolism according to embolus in major pulmonary artery,as well as indirectly suggest the probability of pulmonary embolism in accordance with the sign of right ventricular pressure overload.However,echocardiography could not diagnose and exclude the pulmonary segmental or subsegmental embolism.