经胸超声心动图评价肺血栓栓塞症溶栓疗效的价值

目的探讨经胸超声心动图评价肺动脉血栓栓塞症（PTE）溶栓抗凝疗效的价值。方法对临床确诊为大面积或次大面积PTE的病人35例,应用经胸超声心动图观察溶栓抗凝治疗前及治疗后24h、2周、3个月、6个月右心系统血栓大小、右房室内径、肺动脉和三尖瓣反流频谱、下腔静脉内径的变化。结果溶栓抗凝治疗前发现右心系统血栓29例,右房、右室扩大,右室壁运动幅度降低,右室射血分数降低,肺动脉内径增宽,下腔静脉呼吸变化率减低,肺动脉频谱形态为肺动脉高压型改变,呈双峰或直角三角形,右室射血前期与右室射血时间比值（RPEP/RVET）增大,且均有不同程度的三尖瓣反流。溶栓后各时间段复查,18例血栓逐渐减小消失,9例仅余附壁小血栓,2例血栓大小未见明显变化,回声增高。溶栓后24h,右房室缩小,右室壁运动增强,肺动脉内径缩小,肺动脉压力降低,溶栓后2周继续好转,溶栓后3个月肺动脉压力属正常范围,溶栓后6个月与溶栓后3个月测值比较未见明显差异,但肺动脉血流频谱形态恢复正常。结论经胸超声心动图可作为判断PTE疗效、长期随诊的首选方法。

The Value of Transthoracic Echocardiography for Pulmonary Thromboembolism

Objective To assess the value of transthoracic echocardiography for the assessment of the pulmonary thromboembolism (PTE). Methods Thirty-five patients (pts) with PTE were accepted thrombolytic and anticoagulated treatments. The thrombus, sizes of right atria (RA) and right ventricle (RV), inferior vena cava( IVC), the pulsed-wave of pulmonary artery (PA) and tricuspid regurgitation (TR) were investigated by transthoracic echocardiography pre and post-treatment at 24 h, 2 w, 3 m, 6 m. Results Thrombus was found in right heart system in 29 of 35 pts pre-treatment. The right heart dilatation and RV hypokinesia appeared. The RV ejection fraction (RVEF) decreased. The systolic pressure of PA (PASP) increased. The RPEP/RVET increased. TR was found. At 24 h after treatments, the thrombus became smaller and disappeared gradually. The RA,RV and PA became smaller. The PASP decreased. At 2 w, the parameters continued to improve. At 3 m, the dilatation of right ventricle was slight. At 6m the pulse-wave of PA became normal. Conclusion Transthoracic echocardiography could be the choice for evaluation of the thrombolytic treatments for PE.