超声检查在急性肺栓塞诊断中的价值

目的 探讨超声检查在急性肺栓塞诊断中的价值。方法 对临床综合诊断为肺栓塞的82例患者行经胸超声心动图和周围血管超声检查。结果 超声心动图发现右房内血栓1例，肺动脉干或左、右肺动脉栓塞7例，典型右心负荷过重和肺动脉高压25例。周围血管超声发现下肢深静脉和（或）髂静脉内血栓39例。结论 超声检查是急性肺栓塞影像学诊断的首选，是急诊情况下重要、实用、及时的诊断方法，对临床决策有较大帮助。     

超声检查对肺栓塞的诊断价值

肺栓塞（PE）不是少见的疾病,但因临床医生对此病的认识不足,槿因检查手段的限制而误诊漏诊不少,目前PE的确诊多以血管造影、肺通气灌注扫描、螺旋CT、MRI、X线胸片等为主要手段,而超声检查可以方便,快捷地获得极为有用的信息,并可在床旁进行检查,可作为诊断PE辅助手段之一。     

超声心动图在肺栓塞诊断中的价值

肺栓塞是一种常见病,易误诊、漏诊,病死率约为２４％,如能及时得到诊治,可降至８％,预后明显改善。Ｇｏｌｄｈａｂｅｒ的研究显示,虽然放射性核素和肺动脉造影术应用的增加,１９７９～１９８５年间肺栓塞的病死率并无明显降低［１］。阜外心血管病医院的资料证实肺...     

彩色多普勒超声在诊断肺栓塞及溶栓治疗中的应用

本研究对临床疑似肺动脉栓塞患者进行心脏和下肢深静脉超声检查并观察治疗前后的超声表现,探讨超声对肺动脉栓塞诊断及疗效评估的价值。1对象和方法1.1对象2000-09~2006-09经临床表现、心电图、超声心动图检查、螺旋CT检查等综合确诊的肺栓塞患者28例,男19例,女9例,年龄17~79(5     

彩色多普勒超声检查在急性肺栓塞诊断与治疗中的价值

目的探讨彩色多普勒超声在急性肺栓塞诊断与治疗中的价值。方法对临床综合诊断(包括核素肺灌注扫描、MRI及肺动脉造影)为急性肺栓塞患者30例所进行的彩色多普勒超声心动图及周围血管彩色多普勒超声检查。结果超声心动图检出肺动脉分叉处血栓2例,右心异常改变者21例,其中右室增大伴右室收缩功能减退17例,右室肥厚15例,室间隔运动幅度减低17例,右房增大15例,肺动脉扩张6例。彩色多普勒血流显像在16例患者取得中度至重度三尖瓣反流,用连续多普勒测量三尖瓣反流速度,估测肺动脉收缩压,16例患者肺动脉压升高,范围32～105mmHg(63.5±21.09)mmHg,治疗后肺动脉压明显下降,25.0～55.7(39.6±12.16)mmHg。下肢深静脉彩色多普勒超声检查12例患者检出深静脉血栓,6例血流缓慢伴自发性云雾样回声。结论系统全面、动态的彩色多普勒超声心动图及周围血管彩色多普勒超声检查,对于急性肺栓塞患者的诊断的确立、疗效的评估均有重要价值。     

彩色多普勒超声在肺栓塞鉴别诊断中的临床价值

目的探讨彩色多普勒超声在肺栓塞鉴别诊断中的应用价值。方法经临床诊断的肺栓塞、肺心病、先天性房间隔缺损、右室心肌致密化不全、原发性肺动脉高压患者5组（共154例）行彩色多普勒超声检查,观察心内结构,估测肺动脉压力。结果各组患者右房、右室均增大,肺动脉压力增高。慢性肺栓塞患者可见右室壁及室间隔增厚。急性肺栓塞患者有室壁增厚不明显,部分患者可见肺动脉内栓子形成,肺动脉频谱形态改变。肺心病患者心脏图像显示欠清晰,右室壁增厚,部分心功能减低。房缺患者在房间隔不同部位可见回声连续性中断。右室心肌致密化不全患者右心室内膜面可见粗大的肌小梁和其间深陷的隐窝。原发性肺动脉高压患者除右房、右室内径增大外,心内未见其他畸形。结论彩色多普勒超声在肺栓塞鉴别诊断中具有重要的临床意义。     

彩色多普勒超声心动图在诊断急性肺栓塞中的应用

对我院2004／2007年彩色多普勒超声心动图诊断急性肺栓塞22例分析如下。 1对象和方法 1．1对象患者22例均经同位素肺灌注扫描、螺旋CT或肺动脉造影证实。其中男9例，女13例，年龄19～65（43±21）岁。正常对照组20例，年龄、性别相匹配。     

彩色超声心动图在肺栓塞诊断中的应用30例分析

目的：探讨经胸彩色多普勒超声心动图结合下肢深静脉超声检查在肺栓塞中的诊断价值。方法：回顾分析30例肺栓塞患者的彩色多普勒超声心动图及下肢深静脉彩超表现,结合其他相关检查手段比较分析。结果：本组均经临床和螺旋CT证实,超声发现直接征象2例（右肺动脉近端血栓1例,右心室内血栓1例）,其余皆表现为肺心病表现与肺动脉高压的间接征象表现,28例肺栓塞患者中有20例发现有下肢深静脉血栓,约占72％。结论：彩色多普勒超声心动图是肺栓塞影像学诊断的重要检查手段之一,对临床有很大帮助。     

经胸超声心动图检查在急性肺栓塞诊断与治疗中的价值

目的:探讨经胸超声心动图在急性肺栓塞诊断与治疗中的价值.方法:对经临床综合诊断(包括核素肺灌注扫描或CT血管造影)确诊为急性肺栓塞的患者46例进行经胸超声心动图检查.结果:超声心动图直接检出右室内血栓1例,主肺动脉及左、右肺动脉分支血栓5例.右心异常改变者26例(包括超声直接检出血栓的6例),其中右房室增大19例;右室收缩功能减退21例;室间隔左移、左室短轴切面室间隔向左室膨突呈"D"型改变1例;室间隔运动幅度减低13例;主肺动脉及右肺动脉增宽22例;三尖瓣中量以上返流23例;肺动脉收缩压增高23例,范围在33～81 mmHg(62.87±23.46 mmHg),治疗后肺动脉压明显下降,范围在21～52 mmHg (34.26±13.52 mmHg).结论:动态经胸超声检查是急诊诊断和治疗急性肺栓塞中重要无创影像诊断手段.     

超声评价急性肺栓塞溶栓治疗效果的价值

目的　探讨超声评价经静脉溶栓治疗急性血栓性肺栓塞 (APTE)疗效的价值。方法　超声提示右心压力超负荷征象的APTE患者 2 8例 ,分别在溶栓前和溶栓后 2 4～ 48h行超声和肺通气 -灌注显像检查。结果　 2 2例溶栓有效 ,溶栓后其肺动脉收缩压由 ( 5 7.1± 18.5 )mmHg降至 ( 4 0 .3± 15 .3 )mmHg(P =0 .0 0 0 2 ) ,右室舒张末径由 ( 3 2 .1± 5 .9)mm减小为 ( 2 8.2± 6.4)mm (P =0 .0 0 0 3 ) ,左室舒张末径由 ( 4 1.9± 7.1)mm增加为 ( 4 5 .3± 6.0 )mm (P =0 .0 0 3 ) ,室间隔矛盾运动者由 16例减少为 8例 (P =0 .0 2 ) ,三尖瓣反流量减少 (P =0 .0 0 1)。 6例溶栓无效 ,溶栓前后其参数无明显变化。超声评价溶栓疗效的敏感性、特异性和准确性分别为 86% ,83 %和 86%。结论　溶栓治疗能迅速改善APTE的肺灌注和心功能。超声可敏感地反映溶栓治疗中的血流动力学变化 ,准确评价疗效。     

超声在诊断肺动脉栓塞中的应用研究

目的 探讨无创心血管超声在肺动脉栓塞诊断中的应用价值。方法 对临床综合诊断的35例肺动脉栓塞患者进行经胸超声心动图和下肢深静脉超声检查。结果 超声心动图发现11例肺动脉内血栓直接征象，29例右心系统形态改变，29例肺动脉收缩压升高。周围血管超声检出合并下肢静脉血栓20例。结论 综合运用超声在肺动脉栓塞诊断中的各种检查方法，以提高其敏感性和特异性，对肺动脉栓塞的诊断具有重要的意义。     

超声心动图联合外周血管超声对肺血栓栓塞症的诊断价值

目的 联合应用超声心动图(TTE)和外周血管超声评价右心功能不全(RVD)和下肢深静脉血栓(DVT)对肺血栓栓塞症(PTE)的诊断价值.方法 研究对象为全国41家医院的520例确诊为急性PTE的住院患者.结果 56.0%的患者伴RVD,49.1%存在DVT.363例资料完整患者57.0%有RVD,49.6%伴DVT;伴RVD和(或)DVT者中,33.3%RVD、DVT均阳性.而其中207例(次)大面积PTE,99.5%有RVD,58.5%伴DVT.RVD在近端肺动脉PTE中阳性率(78.9%)明显高于叶肺动脉PTE(51.4%)和段肺动脉PTE(21.7%),DVT阳性率分别为61.7%、46.8%、37.0%,RVD+DVT阳性率分别为51.1%、24.3%和8.7%.结论 RVD/DVT阳性率与PTE严重程度及解剖部位有关,联合TTE和外周血管超声可提高超声技术在急性PTE尤其在(次)大面积PTE、近端肺动脉PTE中的诊断价值.     

脊柱外科手术后静脉血栓栓塞症自然发生率的临床研究

目的 分析脊柱手术后静脉血栓栓塞症（VTE）的自然发生率,探讨采取干预措施抗凝以预防VTE的必要性;结合文献,分析VTE的发生与手术方式、体位、时间等关系,指导临床改进相关环节.方法 2011年1月至2012年1月收治的接受脊柱手术患者168例,术前进行血常规、凝血指标及双下肢静脉彩超检查.术后复查双下肢静脉彩超.随访时间3个月.如果彩超怀疑深静脉血栓（DVT）,行下肢静脉造影确诊;如果高度怀疑肺栓塞（PE）形成,行肺血管造影确诊.统计患者资料及VTE例数.通过SPSS 11.0软件,利用x2检验、Mann-Whitney检验分析.结果 168例患者中确诊VTE1例,无PE病例.脊柱手术后VTE自然发生率为0.60％.尝试分析VTE阳性组与阴性组在性别、年龄、体重、手术时间、部位、入路、失血量、卧床时间等方面是否存在统计学差异.但由于VTE阳性例数少,随机性大,未能进行分析.结论 本次研究结果与文献报道类似,显示脊柱手术围手术期不采用抗凝措施下,VTE自然发生率较低;脊柱手术后对于无VTE症状以及不存在VTE危险因素的患者不需要行双下肢静脉彩超检查、血管造影检查以及常规抗凝处理.     

Burden of illness in venous thromboembolism in critical care: a multicenter observational study

PURPOSE: The frequency of clinically diagnosed venous thromboembolism (VTE) including deep venous thrombosis (DVT) and pulmonary embolism (PE) in medical-surgical critically ill patients is unclear. The objectives of this study were to estimate the prevalence and incidence of radiologically confirmed DVT and PE in medical-surgical intensive care unit (ICU) patients and to determine the impact of prophylaxis on the frequency of these events. MATERIALS AND METHODS: In a retrospective observational cohort study in 12 adult ICUs, we identified prevalent cases (diagnosed in the 24 hours preceding ICU admission up to 48 hours post-ICU admission) and incident cases (diagnosed 48 hours or more after ICU admission and up to 8 weeks after ICU discharge) of upper or lower limb DVT or PE. Deep venous thrombosis was diagnosed by compression ultrasound or venogram. Each DVT was classified as clinically suspected or not clinically suspected in that the latter was diagnosed by scheduled screening ultrasonography. Pulmonary embolism was diagnosed by ventilation-perfusion lung scan, computed tomography pulmonary angiography, echocardiography, electrocardiography, or autopsy. RESULTS: Among 12,338 patients, 252 (2.0%) patients had radiologically confirmed DVT or PE and another 47 (0.4%) had possible DVT or PE. Prevalent DVTs were diagnosed in 0.4% (95% confidence interval [CI], 0.3%-0.5%) of patients and prevalent PEs were diagnosed in 0.4% (95% CI, 0.3%-0.6%). Incident DVTs were diagnosed in 1.0% (95% CI, 0.8%-1.2%) of patients, and incident PEs were diagnosed in 0.5% (95% CI, 0.4%-0.6%). Of patients with incident VTE, 65.8% of cases occurred despite receipt of thromboprophylaxis for at least 80% of their days in ICU. The median (interquartile range) ICU length of stay was similar for patients with DVT (7 [3-17]) and PE (5 [2-8]). For all patients with VTE, ICU mortality was 16.7% (95% CI, 12.0%-21.3%) and hospital mortality was 28.5% (95% CI, 22.8%-34.1%). CONCLUSIONS: Venous thromboembolism appears to be an apparently infrequent, but likely underdiagnosed problem, occurring among patients receiving prophylaxis. Findings suggest the need for increased suspicion among clinicians, renewed efforts at thromboprophylaxis, and evaluation of superior prevention strategies.     

Clinical review of pulmonary embolism: diagnosis, prognosis, and treatment

Pulmonary embolism (PE) is a common disease causing significant morbidity, mortality, and substantial socioeconomic costs. The correct diagnosis and management of PE, however, offers many challenges. As a result, ongoing research continues to develop and refine new and existing diagnostic and prognostic tools, as well as therapeutic interventions, leading to significant improvements in the care of PE over the past 2 decades. This article summarizes the current literature to aid the clinician in the correct integration and implementation of these advances in the treatment of PE.     

超声下不同部位下肢静脉血栓与肺栓塞发生的关联性分析

目的：通过下肢静脉超声检查结果来分析不同部位下肢静脉血栓与肺栓塞之间的关系,为肺栓塞患者的病情评估以及治疗方案提供帮助。方法：回顾性分析2018年1月初至2019年12月底上海交通大学附属胸科医院心内科收治的312例患者,所有患者均行CT肺动脉造影及下肢静脉超声检查,按照检查结果分为肺栓塞组和非肺栓塞组,根据超声检查结果以及病史资料的差别作单因素和多因素相关性分析。结果：两组患者的性别构成比、年龄、肺癌合并情况、下肢静脉血栓发生率及发生部位均存在显著差异（P＜0.05）。肺栓塞组肌间静脉、股静脉、腘静脉、胫后静脉和腓静脉血栓发生率均显著高于非肺栓塞组（P＜0.05）。多因素Logistic回归分析结果表明,存在下肢静脉血栓与肺栓塞的发生存在显著关联（OR= 8.344,95%CI: 4.867- 14.304）,其中存在肌间静脉血栓（OR=2.996,95%CI: 1.630-5.509）、腘静脉血栓（OR=5.536,95%CI: 1.646-18.623）、胫后静脉血栓（OR=6.685,95%CI: 1.789-24.990）均与更高的肺栓塞发生率显著相关。结论：下肢静脉血栓患者的肺栓塞风险显著增加,存在肌间静脉血栓、腘静脉血栓、胫后静脉血栓均为肺栓塞的独立危险因素。     

The effectiveness of anticoagulant and antiplatelet agents in preventing venous thromboembolism during stroke rehabilitation: a historical cohort study

OBJECTIVE: To determine the effectiveness of anticoagulant and antiplatelet agents in preventing venous thromboembolism (VTE) during stroke rehabilitation. DESIGN: Historical cohort study. SETTING: Acute inpatient rehabilitation hospital. PARTICIPANTS: Consecutive patients (N=1506) with ischemic and hemorrhagic stroke admitted for rehabilitation. INTERVENTIONS: Documented use of anticoagulants (warfarin or anticoagulant doses of heparin), heparin in prophylactic doses, and antiplatelet agents. MAIN OUTCOME MEASURE: Occurrence of deep vein thrombosis detected by ultrasound or venography or pulmonary embolism detected by ventilation perfusion scan, spiral computed tomography, or pulmonary angiography. RESULTS: Fifty-eight VTE events occurred (3.9% incidence or 1.36 events per 1000 patient days), with higher risk in patients with severe stroke. Only therapeutic anticoagulation had a statistically significant protective effect for VTE risk in univariate analysis (odds ratio [OR]=.44; 95% confidence interval [CI],.20-.98). After adjusting for multiple medication use and other factors, including age, stroke onset to admission interval, length of rehabilitation stay, cause of stroke, and admission National Institutes of Health Stroke Scale score, therapeutic anticoagulation gave strong protection against VTE (OR=.37; 95% CI,.15-.88), followed by heparin (OR=.48; 95% CI,.23-.98) but not by antiplatelet agents (OR=.79; 95% CI,.40-1.57). No medications were associated with significant bleeding complications. CONCLUSIONS: Use of therapeutic anticoagulants or prophylactic heparin prevented VTE in stroke patients during inpatient rehabilitation.     

CT肺动脉成像联合下肢静脉成像评估肺动脉栓塞与下肢深静脉血栓的相关性

目的探讨应用CT肺动脉成像(CTPA)联合下肢静脉成像(CTV)技术,分析肺动脉栓塞(PE)与下肢深静脉血栓(DVT)关系的价值.方法 回顾性分析374例因怀疑下肢深静脉血栓而接受CTPA联合下肢CTV检查的患者资料,分别评估左下肢、右下肢、双下肢DVT并发PE的风险,分析PE与下肢DVT的相关性.结果 共检出下肢DVT 288例,PE 155例;下肢DVT合并PE共145例.共检出DVT病变血管321条,左下肢DVT的发生率(211/321,65.73%)明显高于右下肢(110/321,34.27%),差异有统计学意义(χ²=71.783,P<0.001).50.35%(145/288)的下肢DVT患者合并PE,左下肢、右下肢、双下肢DVT合并PE患者分别占44.38%(79/178)、58.44%(45/77)、63.64%(21/33),差异有统计学意义(χ²=6.883,P=0.032).93.55%(145/155)的PE患者合并下肢DVT,PE合并左下肢、右下肢、双下肢DVT的患者分别占50.97%(79/155)、29.03%(45/155)、13.55%(21/155),差异无统计学意义(χ²=13.025,P>0.05).PE与DVT呈正相关(r=0.8).结论 PE的发生与下肢DVT呈正相关,应用CTPA联合下肢CTV诊断下肢DVT可同时判断是否合并PE,有利于及时合理治疗,减低PE病死率.