肺灌注/通气显像在肺动脉栓塞诊断中的价值

目的:评价核素肺通气/灌注(V/Q)显像在肺动脉栓塞(PE)诊断中的价值。方法:回顾总结40例核素肺灌注/通气显像与肺动脉造影(CPA)诊断PE的对照研究。结果:31例患者V/Q显像示不相匹配的肺叶、肺段或多发亚肺段的放射性分布稀疏或缺损,提示为PE,其中肺动脉造影证实30例为PE,1例多发大动脉炎;9例患者的V/Q显像为相匹配的肺叶、肺段或多发亚肺段的稀疏或缺损,提示不是PE,与肺动脉造影结果一致。核素V/Q显像诊断PE的灵敏度为100%(30/30例),特异性为90.0%(9/10例),准确性为97.5%(39/40例)。结论:多数PE患者通过核素肺V/Q显像可以作出明确诊断,少数肺V/Q显像与临床表现不符的患者需行肺动脉造影。     

肺动脉造影与核素肺灌注/通气扫描在肺栓塞诊断价值相关性研究

目的 :探讨选择性肺动脉造影与核素肺灌注 通气扫描在肺栓塞诊断的相关性。方法 :回顾性分析 2 3例肺栓塞选择性肺动脉造影与核素肺灌注 通气扫描显像。结果 :2 3例选择性肺动脉造影与核素肺灌注 通气扫描显像结果比较 ,肺血管堵塞≥ 8支以上者 ,二者相关性达 10 0 % ;<8支者二者相关性为 90 5 %。 7例冠状动脉造影阴性患者 ,经肺动脉造影证实为肺栓塞。结论 :选择性肺动脉造影是临床肺栓塞诊断和病变定位的可靠依据 ,而核素肺灌注 通气扫描显像检查则是目前临床诊断肺栓塞的有价值的无创性诊断方法之一。     

64层螺旋CT与核素肺灌注/通气显像对于肺栓塞的诊断价值

目的探讨64层螺旋CT肺动脉造影(CTPA)与核素肺灌注/通气(V/Q)显像对肺栓塞(PE)的诊断价值。方法对154例疑似PE患者的肺V/Q显像和CTPA结果进行比较,比较两者对PE诊断的敏感性和特异性。结果 CTPA诊断PE的检出率、敏感性、特异性明显高于V/Q显像(81.2%vs 57.8%,87.5%vs 71.2%,74.6%vs 69%,均P<0.01)。结论核素肺V/Q显像相比64层螺旋CT增强扫描对于PE具有较高的诊断价值,可以是PE影像学诊断的金标准。     

肺栓塞的核素显像检查

肺栓塞的核素显像诊断已有 4 0年的历史。196 1年Ｔａｐｌｉｎ等用 131　Ｉ 聚合人血清白蛋白研究吞噬细胞时发现肺组织沉积。 196 4年Ｗａｇｎｅｒ等[1] 将其用于肺灌注显像诊断肺栓塞。 1972年我国开始应用113ｍＩｎ 氢氧化铁进行肺灌注扫描[2 ] ,因发现氢氧化铁副作用较多 ,改用99ｍＴｃ 标记聚合人血清白蛋白(ＭＡＡ) ,至今也有 30余年的历史 ,积累了大量经验。临床应用证明 :肺灌注显像方法简便安全 ,如结合胸部Ｘ线平片或肺通气显像 ,对肺栓塞诊断与肺动脉造影的符合率在 90 %以上 ,现已成为肺栓塞临床诊断、疗效观察、预后判断的重要…     

肺灌注显像和肺动脉造影对大动脉炎患者的肺动脉病变的诊断比较

目的比较大颗粒聚合人血清白蛋白（99Tcm-MAA）肺灌注显像和肺动脉造影诊断大动脉炎患者的肺动脉病变的能力.方法对21例（女性19例,男性2例）经临床确诊的大动脉炎患者的99Tcm-MAA肺灌注显像和肺动脉造影结果进行回顾性分析.结果 11例肺动脉造影证实有肺动脉受累的患者,肺灌注显像均不正常;在肺动脉造影正常的10例患者中,8例肺灌注显像正常,另外2例肺灌注显像提示有灌注受损.因此,从对大动脉炎患者的肺动脉受累的检出上看,肺灌注显像和肺动脉造影总的诊断符合率为90.5%（19/21,Kappa值= 0.81, P〈 0.0001）.在对受累肺段的检出上（狭窄和闭塞性病变）,肺灌注显像和肺动脉造影总的诊断符合率为87.5%（331/378,Kappa值 = 0.74, P〈 0.0001）.结论对于大动脉炎患者的肺动脉病变的诊断,99Tcm-MAA肺灌注显像和肺动脉造影有良好的诊断符合率.肺灌注显像可以作为大动脉炎患者的肺动脉病变的一种无创性筛选检查.     

合并复杂病情的急性大面积肺栓塞的溶栓治疗

目的 :评价急性大面积肺栓塞合并复杂病情的溶栓疗效。方法 :对急性大面积肺栓塞合并复杂病情的 7例患者于溶栓前、后行心电图、动脉血气、超声心动图、肺灌注显像及电子束计算机断层摄影术 (EBCT)检查 ,评价溶栓疗效。结果 :7例大面积肺栓塞患者合并复杂病情 ,包括 :例 1合并妊娠、例 2和例 3反复发生肺栓塞、例 4并发休克、例 5并发矛盾性右肾动脉及肠系膜动脉栓塞、例 6为 82岁高龄及例 7肺灌注显像正常 ,而EBCT显示大块血栓堵塞主肺动脉内。 6例予重组组织型纤溶酶原激活剂 ,1例予尿激酶溶栓治疗。溶栓前平均动脉血氧分压及动脉二氧化碳分压分别为 62 9mmHg(1mmHg =0 133kPa)、31 6mmHg ,溶栓后分别上升至 82 0mmHg、36 6mmHg。超声心动图显示溶栓前右心室内径及估测肺动脉收缩压分别为 32 7mm、5 6 3mmHg ,溶栓后为 2 2 8mm、37 9mmHg。 7例肺灌注显像示溶栓前缺损肺段 7～ 15个不等 ,溶栓后 5例仅残余 3～ 5个肺段的缺损 ,肺灌注明显改善 ,2例正常。所有患者临床症状明显改善或完全消失 ,7例患者均好转出院。结论 :急性大面积肺栓塞合并复杂病情 ,如能得到正确诊断和及时有效的治疗 ,可挽救患者生命 ,改善预后。     

肺通气/灌注显像对急性肺血栓栓塞症的诊断及疗效评价

目的评价放射性核素肺通气／灌注显像对急性肺栓塞的诊断价值及溶栓效果的价值。方法对65例临床确诊或高度怀疑急性肺栓塞、病程在2周以内的患者,进行肺通气／灌注显像检查,对具备溶栓指征者实行静脉溶栓治疗,对所有诊断为肺栓塞的患者均进行抗凝治疗,于治疗后15-30d复查肺灌注显像。结果在65例患者中,高度可能性肺栓塞患者45例,中度可能性患者12例,低度可能性患者8例。对30例具备溶栓指征且无溶栓禁忌证的患者进行了溶栓治疗。随诊肺灌注显像显示51例患者的肺灌注有改善,其中高度可能性肺栓塞患者41例,中度可能性患者9例,低度可能性患者1例,另14例无变化。结论肺通气／灌注显像是诊断急性肺栓塞判断治疗效果的一种无创、安全、可靠、可重复的检查方法,可作为急性肺栓塞患者常规的检查手段。     

肺通气/灌注显像与CT肺动脉造影诊断肺栓塞的对比研究

目的探讨肺通气/灌注（V/Q）显像与CT肺动脉造影（CTPA）在肺栓塞（PE）诊断中的价值。方法将93例肺栓塞患者分为两组（大面积、次大面积肺栓塞组和非大面积肺栓塞组），分别对全体患者、不同分组患者肺V/Q显像与CTPA的诊断价值进行对比分析。结果肺V/Q显像与CTPA总检出率比较无明显差异（P〉0.05）；在非大面积肺栓塞组中肺V/Q显像检出率高于CTPA（P〈0.05）；在大面积、次大面积肺栓塞组中CTPA检出率高于肺V/Q显像（P〈0.05）。结论CTPA与肺V/Q显像诊断肺栓塞各有优缺点，应将两种诊断技术优势互补，才能为临床治疗提供更加准确的有效信息。     

螺旋CT增强的肺动脉造影和放射性核素肺通气/灌注显像相结合在肺栓塞诊断中的作用

目的探讨螺旋CT增强的肺动脉造影（SCTPA）和放射性核素肺通气/灌注（V/Q）显像二者结合,在肺栓塞（PE）诊断中的作用。方法对高度怀疑肺栓塞的患者,在就诊24～36h内做SCTPA和V/Q显像检查,并对其结果进行分析。结果SCTPA对检出段以上PE有明显优势,V/Q显像在检出亚段PE上有优势,二者均为无创检查,相互结合,同时发挥了核素肺V/Q显像高敏感度和SCTPA高特异性的优势,可减少误诊及漏诊,准确评价病情,在临床工作中有广泛的应用前景。结论SCTPA和V/Q显像检查相结合有望代替肺动脉造影（PA）,使得PE诊断迈上新的台阶。     

急性肺动脉血栓栓塞症核素肺灌注显像与电子束计算机断层摄影术的对比研究

目的通过对急性肺栓塞患者的核素肺灌注显像与电子束计算机断层摄影术(EBCT)的对比分析,初步探讨两者之间存在差异的原因和规律,以及肺动脉血管阻塞与血流灌注变化之间的对应关系。方法20例急性肺栓塞患者,24h内先后接受核素肺灌注显像和EBCT肺血管增强造影。逐个肺段对比EBCT所显示的肺动脉阻塞与肺灌注显像所显示的肺血流灌注的情况。结果多数(81.7%)肺动脉完全闭塞型病变对应相应肺段的灌注完全缺失,血流灌注分布与非完全闭塞型病变相比有显著性差异(P<0.01)。在非完全闭塞型病变中,多级肺动脉病变对应灌注完全缺失的比例较高(60.0%),多级肺动脉病变与单级肺动脉病变相比,血流灌注亦有明显的差异(P<0.05)。而不同类型的非完全闭塞型病变所对应的血流灌注没有明显差异(P>0.05)。结论不同形式的血管阻塞所造成的血流灌注变化的不同,是EBCT与肺灌注显像存在差别的主要原因之一,肺栓塞的血管阻塞和灌注受损是相互联系又有所不同的两个方面,肺灌注显像和EBCT结合应用能够使肺栓塞的诊断和疗效评价更加全面准确。     

58例急性肺栓塞治疗方案的选择与评估

目的 探讨急性肺栓塞（ＡＰＥ）的最佳治疗方案。评估重组组织型纤溶酶原激活剂和尿激酶（ＵＫ）２小时连续静脉溶栓法的可行性及临床疗效。方法 ５８例经放射性核素肺灌注通过扫描（ＥＣＴ）或选择性肺动脉造影（ＣＰＡ）确诊为ＡＰＥ的患者,采用ｒｔ－ＰＡ或ＵＫ２小时连续静脉滴注法（简称２小时法）或ＵＫ小剂量每日１次３￣７日法溶栓及单纯抗凝法,栓子切除法治疗。比较并分析不同治疗方案的临床疗效。结果 溶栓治疗４１例     

核素肺灌注显像对急性肺血栓栓塞症溶栓疗效的观察

目的　应用核素肺灌注显像评价急性肺血栓栓塞症患者溶栓前后肺血流灌注的变化情况。方法　 80例急性肺栓塞患者溶栓前后均行肺灌注显像。应用半定量法分析图像 ,计算灌注缺损百分数 (PPDs) ,溶栓前、溶栓后 1～ 5d、6～ 30d和 3个月以上PPDs分别表示为PPDsD0 、PPDsD5、PPDsD3 0 和PPDsM3 。结果　全部 80例患者PPDsD0 平均为 (5 7 3± 16 4 ) %。其中 6 4例溶栓前PPDsD0为 (5 5 5± 16 8) % ,溶栓后早期PPDs明显降低 ,PPDsD5为 (4 0 0± 18 6 ) % ,两者比较P <0 0 0 1。其中30例PPDsD0 ,PPDsD5和PPDsD3 0 分别为 (5 7 5± 16 1) % ,(39 3± 16 8) %和 (2 9 5± 17 3) % ,三者之间差异均有显著性 ,均为P <0 0 0 1。溶栓 3个月以后 ,PPDs仍有一定程度的减低 ,11例患者PPDsD3 0 和PPDsM3 分别为 (4 0 9± 18 1) %和 (2 9 1± 2 7 1) % ,P <0 0 5。病程在 7天以内和病程在 8～ 14天的两组患者溶栓后PPDs均有十分明显的降低 ;而病程在 14天以上的患者 ,溶栓后PPDs也有一定程度的降低 ,但降低的程度小于前两组患者。结论　应用肺灌注显像可以准确观察溶栓后肺血流灌注的动态变化过程 ,是评价急性肺栓塞溶栓疗效的简便可靠的常规方法     

Pulmonary angiography in the diagnosis of pulmonary embolism

In patients in whom there is clinical suspicion of pulmonary thromboembolic disease, because of the risk of inadequate treatment, definitive radiologic evaluation should be carried out. Of the diagnostic procedures available, conventional pulmonary angiography has the greatest sensitivity and specificity in the detection of pulmonary embolism or other pulmonary vascular disease. Pulmonary angiography is indicated for patients with an indeterminate lung scan, for those with a high-probability lung scan in whom confirmation is necessary because of high risk for bleeding complications from anticoagulation, if embolism is massive and embolectomy is contemplated, if thrombolytic therapy or vena cava interruption is considered or if there is significant clinical evidence for an alternative diagnosis as well as for those with low-probability scans with a high degree of clinical suspicion and to complete a workup in patients with pulmonary hypertension. Refinements in the technique have simplified and expanded its application. The hemodynamic evaluation with right-heart catheterization before and after pulmonary angiography plays an important role in the choice of treatment of pulmonary embolism. In patients with multiple bilateral lobar or segmental perfusion defects, performance of right and left pulmonary arteriography in the right and left posterior oblique projections should be carried out. In the presence of additional pulmonary hypertension, the lung in which perfusion is most abnormal is selected first for angiography with a low bolus contrast dose. The angiographic criteria for the diagnosis of pulmonary embolism are intraluminal vascular filling defects or an abrupt cutoff of a large vessel. For selective opacification of lobar pulmonary branches occlusion pulmonary angiography is helpful. The mortality of pulmonary angiography in experienced centers is approximately 0.3%. Complications may include cardiac perforation in up to 1% and subendocardial injury in less than 0.2%. In patients with pulmonary embolism but no pulmonary hypertension, treatment with heparin for ten to 14 days should be followed by coumadin anticoagulation for at least three to six months. For obstruction of greater than or equal to 50% of the pulmonary vascular cross-sectional area and pulmonary hypertension thrombolytic therapy should be given and insertion of an inferior caval filter can be considered. In those with more than 75% pulmonary vascular obstruction and corresponding hemodynamic derangement, pulmonary artery embolectomy or thrombolytic therapy should be carried out.4     

老年人肺栓塞的临床特点及溶栓治疗

目的 探讨老年人肺栓塞的临床特点及溶栓、抗凝治疗的疗效.方法 回顾性分析72例60岁以上肺血栓栓塞患者的临床表现、诊断方法及溶栓、抗凝治疗和转归.结果 本组72例老年急性肺栓塞患者均患2种和(或)2种以上慢性疾病,其中高血压41例(56.9%),下肢深静脉血栓30例(53.6%),冠心病26例(36.1%),肿瘤9例(12.5%),手术和骨折15例(20.8%).72例患者中出现呼吸困难66例(91.7%),咳嗽22例(30.6%),胸痛20例(27.8%),紫绀13例(18.1%),晕厥10例(13.9%),咯血9例(12.5%),下肢水肿32例(44.4%),肺部湿哕音23例(31.9%),P2亢进13例(18.1%),血管杂音4例(5.6%).血氧分析61例中53例(86.9%)有不同程度的低氧血症,其中37例(60.7%)伴低碳酸血症.31例患者检测肺泡动脉氧压差,其中有27例增高(87.1%).56例血管超声检查,发现有不同程度的下肢深静脉血栓者30例(53.6%).61例患者常规取血行D-二聚体检查,50例呈阳性,阳性率82.0%.62例患者行螺旋CT肺动脉造影(CTPA)检查,其中58例有肺段以上肺动脉不同部位血栓,阳性率为93.5%.CT影像中肺动脉纤细及肺纹理稀疏6例,梗死灶8例,片状影10例,马赛克征及肺动脉增粗2例.16例患者行核素肺通气/灌注(V/Q)显像检查,均显示高度可能肺栓塞,阳性率为100%.进一步行CTPA检查,该16例均发现肺段以上肺动脉血栓形成,阳性率100%.72例均行溶栓抗凝治疗,治愈1 6例(22.2%),显效22例(30.6%),有效25例(34.7%),无效或恶化9例(12.5%),其中5例(6.9%)死亡.溶栓和抗凝治疗效果明显优于单纯抗凝治疗(有效率:86.2%对30.2%,P＜0.01),治疗中未出现出血现象.结论 老年肺栓塞最常见危险因素为高血压和下肢深静脉血栓形成,其临床表现以呼吸困难为首发,症状复杂多样且不典型,CTPA对老年肺栓塞诊断具有可靠性和准确性,溶栓抗凝治疗安全、有效.     

The effectiveness of thrombolytic therapy in patients with massive and submassive pulmonary thromboembolism

Thrombolytic therapy is the most effective therapy for massive pulmonary embolism (PTE). In this study we evaluated the symptoms, clinical and radiologic features and response to thrombolytic therapy in patients who had massive or submassive PTE. Thrombolytic therapy was administered for a mean period of 3 (1-5) hours to 19 patients with a mean age of 63.7 years who had the diagnosis of PTE based on symptoms which lasted for an average of 72 (2-240) hours and findings of echocardiography, spiral computed tomography (CT) angiography and perfusion scan. The patients to whom heparin infusion and oral anticoagulant treatment were given after thrombolytic therapy were evaluated. Bleeding as a complication was noted in six patients after thrombolytic therapy. Two patients died due to this complication. Control spiral CT angiography was performed to 12 of 15 (80%) patients who were initially diagnosed PTE by spiral CT angiography. While marked regression was noted in 5 (41.7%) patients in the early phase (second week), in 7 (58.3%) patients in the late phase (sixth month) PTE findings were completely disappeared. The median value of pulmonary artery pressure was 65 (45-70) mmHg before and 39.5 (30-45) mmHg after the treatment. Of the genetic factors studied before thrombolytic therapy, antithrombin III deficiency was found as the most common one. This study demonstrates that spiral thorax CT angiography is a very accurate diagnostic tool for the definitive diagnosis and transthoracic echocardiography is very useful for the rapid diagnosis and to decide for thrombolytic therapy, in especially patients who are not hypotensive and have submassive to massive PTE, and support the idea that thrombolytic therapy is life saving after reaching the certain diagnosis.     

70例肺栓塞临床特点及危险因素分析

目的提高对肺栓塞的诊断率,降低误诊率。方法对70例肺栓塞患者的临床特点、理化检查、治疗手段及危险因素进行回顾性分析。结果70例患者中,最常见的症状为呼吸困难者占92．9％,D-二聚体〉500μg／L者占92．9％,动脉血氧分压〈80mmHg者占95．7％,行CT肺动脉造影检查提示肺动脉段以上充盈缺损或肺栓塞者占92．1％,为主要诊断方法;27例患者接受溶栓治疗,40例选择单纯抗凝治疗,3例因出血未行抗凝治疗,共24例行下腔静脉滤器植入术以预防再次肺栓塞的发生;治愈7例占10％（均为溶栓治疗）,好转60例占85．7％;死亡3例占4．3％（均未行溶栓治疗）。结论肺栓塞临床表现复杂,理化检查多不具特异性,CT肺动脉造影为首选诊断方法,必要时行肺动脉造影检查,溶栓风险高,但治愈率高。     

Subacute massive thromboembolic occlusion of a main pulmonary artery. Report of a case successfully treated by thrombolytic therapy and review of the literature

Subacute massive thromboembolic occlusion of the left main pulmonary artery in a 52-year-old woman is described. This disease remains a rare entity with a much less dramatic presentation than acute massive pulmonary embolus. The presenting symptom was unexplained dyspnea. Physical signs and laboratory tests were nonspecific. The perfusion scan is the best screening test for this disorder. Antemortem diagnosis is established by pulmonary angiography. A literature review undertaken to ascertain the incidence of this entity as well as to recommend treatment of choice, be it medical or surgical therapy, was unrewarding. We decided to use thrombolytic therapy and found a marked improvement in the patient's symptoms and perfusion scan after 24 hours. Although thrombolytic therapy is commonly indicated for acute massive pulmonary embolism, we believe this mode of therapy should also be the initial treatment for subacute massive pulmonary thromboembolism.     

肺灌注显像评价急性肺栓塞药物治疗的疗效

目的 :评价99mTc MAA肺灌注显像对判断急性肺栓塞溶栓继以抗凝治疗的效果及预后价值。方法 :肺栓塞患者 16例 ,治疗前、治疗后 1周、1个月和 3个月均行肺灌注显像 ,结果 :患者经溶栓继以抗凝治疗 1周后 ,临床好转 ,肺灌注显像 42 .2 %的稀疏缺损区得到不同程度的放射性填充 ;1个月及 3个月后复查 ,分别有 6 6 .9%、72 .1%的稀疏缺损区得到不同程度的放射性填充。结论 :肺灌注显像为无创性检查 ,根据稀疏缺损变化可随访观察肺栓塞的消退 ,选择用药并及时调整治疗方案。