血管内皮功能研究现状

自从生理学家Ｈｉｓ于 186 5年首先提出内皮这一概念后 ,人类对它的研究始终方兴未艾。新近越来越多的研究发现血管内皮功能失调参与多种心血管疾病的发病 ,并认为内皮功能失调是发生动脉粥样硬化的最初事件即“启动子”[1 ] 。如今 ,遴选出一种既经济又简便的方法来评估血管内皮功能以及采取某种合适的方式来保护或挽救血管内皮功能将是心血管疾病防治史上的一个新的里程碑。我们着重对血管内皮的功能及其评估方法、内皮功能失调的治疗作一综述。1　正常血管内皮的功能1.1　屏障作用　血管内皮衬于血管内壁 ,起屏障作用 ,将血管内外分开 ,…     

幼龄自发性高血压大鼠血管内皮功能研究

目的　本研究选取幼龄自发性高血压大鼠(SHR)作为研究对象 ,观察其尚未出现高血压时血浆一氧化氮 (NO)、血管壁一氧化氮合酶 (NOS)的情况及负荷运动对它的影响 ,从而进一步了解内皮功能在遗传性高血压发病中的地位。方法　 5～ 6wSHR、WKY各 2 8只随机分为静态组、运动组 ,静态组行有创血压测定、血浆NO及血管壁NOS测定 ,运动组行游泳负荷运动后行上述指标测定 ,分别比较静态组WKY、SHR 6min内的平均血压、峰血压、达峰时间、血浆NO的均数和运动组WHY、SHR的上述指标的均数 ,比较各组NOS免疫组化染色。结果　 (1)静态组WKY、SHR6min内的平均血压、峰血压、达峰时间有显著差异 (P <0 0 5 ) ;运动组WKY、SHR的平均血压、峰血压、达峰时间没有显著差异 (P >0 .0 5 ) ;(2 )静态组WKY、SHR的血浆NO无显著差异 (P <0 .0 5 ) ,运动组WKY、SHR的NO有显著差异(P <0 .0 5 ) ;无论是SHR还是SKY ,其运动组血浆NO均高于静态组 ,但WKY鼠运动组比静态组增高更明显 ;(3)各组血管壁NOS免疫组化染色范围未见明显不同。结论　SHR在高血压期前已存在内皮舒血管储备功能的不足。推测内皮舒血管功能的障碍可能参与了遗传性高血压的发病。     

胰岛素抵抗大鼠内皮依赖性血管舒张功能研究

目的　探讨高脂饲料诱导胰岛素抵抗 (IR )动物模型的内皮功能变化及其机制。方法　高脂饲料喂养大鼠 4周 ,建立IR动物模型 ,并用正葡萄糖高胰岛素钳夹技术的葡萄糖输注率 (GIR)评价IR。观察大鼠离体主动脉对乙酰胆碱 (Ach)依赖性血管舒张功能反应和一氧化氮合酶 (NOS) 一氧化氮 (NO) cGMP功能状态。结果　 ( 1)高脂饲料组大鼠的GIR显著低于正常饲料组大鼠 (P <0 .0 1) ,且GIR水平与大鼠体重呈显著负相关 (r =-0 .75 ,P <0 .0 1)。 ( 2 )高脂饲料组大鼠离体主动脉条对Ach依赖性血管舒张功能反应显著降低 ,最大舒张反应降低 13 .8% (P <0 .0 1) ,高脂饲料组大鼠主动脉NO及cGMP浓度明显低于普通饲料组大鼠 (均P <0 .0 5 ) ,两组大鼠主动脉NOS浓度无明显差别。 ( 3 )大鼠主动脉条对Ach依赖性血管舒张功能反应与NO水平呈显著负相关 (r =-0 .65 ,P <0 .0 5 )。结论　 ( 1)应用正葡萄糖高胰岛素钳夹技术显示 ,在高脂饲料饲养 4周的大鼠建立了IR大鼠模型。 ( 2 )高脂饲料饲养大鼠的内皮细胞功能减弱 ,其机制与NO水平降低密切相关。     

瑞舒伐他汀改善糖尿病大鼠血管内皮功能的实验研究

目的 评价不同剂量瑞舒伐他汀对糖尿病大鼠血管内皮功能的保护作用.方法 24只糖尿病大鼠随机分为3组:糖尿病对照组、瑞舒伐他汀20 mg组(RV 20 mg组)和10 mg组(RV 10mg组);8只健康SD大鼠作为正常对照组.给药共8周,分别于给药前和给药后第8周测定血浆内皮素-1(ET-1)、一氧化氮(NO)、血糖、血脂含量.结果 用药前糖尿病大鼠各组血糖均显著高于正常对照组(P＜0.01);RV 20 mg和RV 10 mg组在给药后第8周血糖稍低于糖尿病对照组,但差异无统计学意义(P＞0.05).糖尿病对照组血浆NO浓度明显低于SD正常对照组(P＜0.05),给药8周后,用药组血浆NO浓度明显高于糖尿病对照组(P＜0.01或P＜0.05).糖尿病对照组血浆ET-1浓度高于SD正常对照组(P＜0.05);给药8周后,用药组血浆ET-1浓度明显低于糖尿病对照组(P＜0.01或P＜0.05).RV 20 mg组和RV 10 mg组比较,血浆E-1浓度降低及血浆NO浓度升高(P＜0.05).同时,RV 20 mg组和RV 10 mg组血胆固醇水平明显低于糖尿病对照组(P＜0.01).结论 瑞舒伐他汀可明显降低糖尿病大鼠的血胆固醇水平,同时通过提高血浆NO浓度和降低E-1浓度等机制改善血管内皮功能.

Abstract：

Objective To evaluate the effects of two different dosage of rosuvastatin on endothelial dysfunction in diabetic rats. Methods The 24 diabetic rats were randomly divided into three groups (n=8,each): diabetic control group, 20 mg rosuvastatin daily (RV 20 mg group) and 10mg rosuvastatin daily for 8 weeks (RV 10 mg group) and normal control group (SD group). The levels of blood glucose, lipid, nitric oxide(NO) and endothelin-1 (ET-1) were measured before and 8 weeks after treatment. Results The levels of blood glucose were higher in all diabetic rats groups than in SD group before experiment (P＜0. 01). Compared with diabetic rats control group, blood glucose was slightly lower in RV 10 mg group and RV 20 mg group at 8 weeks (P＞0. 05). The plasma NO level was significantly lower in diabetic rats control group than in SD group (P＜0. 05).After 8 weeks, plasma NO levels were significantly higher in RV 20 mg and RV 10 mg groups than in diabetic rats control group (P＜0. 01 or P＜0. 05). The plasma levels of ET-1 was significantly higher in diabetic rats control group than in SD group (P＜0. 01). After 8 weeks, plasma ET-1 levels were significantly lower in RV 20 mg and RV 10 mg group than in diabetic rats control group (P＜0. 01).Meanwhile, the plasma lipids were lower in RV 20 mg and RV 10 mg group than in diabetic control group (P＜0. 05 or P＜0. 01). Conclusions Rosuvastatin can adjust blood lipids and significantly improve endothelial function in diabetic rats by increasing plasma NO level and decreasing plasma ET-1 level.     

高尿酸血症大鼠血尿酸与血管内皮功能相关性的研究

目的：探讨高尿酸大鼠血尿酸与血管内皮功能的关系。方法：雄性SD大鼠36只,随机均分为正常对照组、模型组和别嘌醇治疗组。使用高酵母膏饲料联合氧嗪酸钾腹腔注射6周诱导大鼠高尿酸模型。别嘌醇治疗组除给予造模剂外同时以别嘌醇灌胃6周。定期测量大鼠收缩压。6周后处死大鼠,检测各组血清尿酸（SUA）、一氧化氮（NO）、内皮素-1（ET-1）、收缩压（SBP）等的变化,用免疫组化法检测大鼠主动脉内膜层内皮型一氧化氮合酶（eNOS）的表达量。结果：与正常对照组相比,模型组大鼠SUA水平[（45.1±5.6）μmol/L∶（216.0±6.2）μmol/L]显著升高（P〈0.001）,ET-1[（85.4±8.7）μg/L∶（163.1±7.2）μg/L]、SBP[（115.7±4.1）mm-Hg∶（156.0±3.8）mmHg]显著升高,血NO[（24.1±2.0）μmol/L∶（17.2±3.4）μmol/L]及主动脉内膜层eNOS[（48.3±4.2）∶（38.3±4.5）]表达量显著降低（P均〈0.05）;与模型组比较,别嘌醇组SUA[（44.8±4.3）μmol/L]、ET-1[（92.8±5.0）μg/L]、SBP[（119.2±4.3）mmHg]水平显著降低,血NO[（22.1±2.2）μmol/L]和主动脉内膜eNOS的表达量（46.1±4.2）明显升高（P均〈0.05）,别嘌醇组与正常对照组比较上述指标无明显差异（P〉0.05）。SUA与SBP、ET-1呈正相关（r=0.98、0.98,P均〈0.001）,与NO呈负相关（-0.70,P〈0.001）。结论：高尿酸血症与大鼠血管内皮功能紊乱密切相关。血一氧化氮的降低和内皮素-1的升高可能是发生高血压的重要原因之一。别嘌醇具有保护血管内皮功能的作用。     

血管内皮功能与血管重塑

血管内皮具有强大的生理功能,内皮功能障碍参与心血管疾病的发生、发展.近年的研究表明,血管重塑对心血管疾病的意义愈见明显,而内皮细胞在血管重塑过程中发挥重要作用,内皮功能障碍可影响血管重塑的程度和性质.本文就正常血管内皮功能及其在血管重塑过程中的作用以及内皮功能障碍与血管重塑的关系作一综述.     

罗格列酮对2型糖尿病大鼠主动脉内皮依赖性血管舒张功能的影响

目的观察2型糖尿病（T2DM）大鼠胸主动脉内皮依赖性血管舒张功能和一氧化氮（NO）、一氧化氮合酶（eNOS）的变化及罗格列酮（RSG）治疗对其内皮功能的影响。方法SD大鼠经高糖高脂喂养6周后予小剂量链脲佐菌素腹腔注射建立T2DM大鼠模型，糖尿病大鼠又分为对照（DM）组和RSG治疗组，RSG组用RSG干预8周，另选正常大鼠为正常对照（NC）组。实验终止时用正常葡萄糖高胰岛素钳夹技术的葡萄糖输注率（GIR）评价胰岛素抵抗，观察大鼠离体主动脉内皮依赖性血管舒张反应和主动脉NO、eNOS的变化。结果T2DM大鼠GIR、胸主动脉内皮依赖性血管舒张反应、主动脉NO含量及eNOS阳性表达较NC组显著降低（P〈0、01），RSG治疗后上述指标均显著升高（P〈0．05）。结论T2DM大鼠存在内皮依赖性血管舒张功能紊乱，RSG治疗可改善内皮功能，增强NO水平和eNOS的活性。     

一氧化氮对自发性高血压大鼠血管内皮功能的作用

目的　探讨自发性高血压大鼠 (SHR)内皮舒张功能不全的发生机制。方法　采用体外灌注的方法测定大鼠胸主动脉环对不同浓度乙酰胆碱的舒张反应变化 ,并测定血清中NO-3浓度和动脉组织中环鸟苷酸水平。结果　与魏 凯二氏大鼠 (WKY)比较 ,SHR胸主动脉环对乙酰胆碱的舒张反应明显减弱。左旋硝基精氨酸 (L NNA)可明显抑制大鼠胸主动脉环对乙酰胆碱的舒张反应 ,但并不能消除SHR和WKY对乙酰胆碱舒张反应之间的差异。与WKY比较 ,SHR血中NO-3水平明显降低 (P<0 .0 1) ,动脉组织中环鸟苷酸含量降低 (P<0 .0 1)。结论　SHR内皮依赖的血管舒张功能减低 ;一氧化氮 (NO)的生成或释放不足可能直接参与了SHR血管内皮依赖的舒张功能不全。     

血管内皮功能障碍与冠状动脉疾病

长时间以来 ,我们认识到冠心病 (ＣＨＤ)发生的独立危险因素为高胆固醇血症、高血压、吸烟及糖尿病。晚近又增加几种危险因素 :高同型半胱氨酸血症、肺炎衣原体和内皮炎症等。近年来随着经皮腔内冠状动脉成形术 (ＰＴＣＡ)的广泛开展 ,越来越多的证据表明 :冠状动脉造影显示的狭窄程度与临床症状和急性冠状动脉事件的发生无明显相关性。这一发现促使人们深入探求心肌缺血发生的根本机理。1980年Ｆｕｒｃｈｇｏｔｔ和Ｚａｗａｄａｋｉ[1] 发现了血管内皮细胞 (ｅｎｄｏｔｈｅｌｉａｌｃｅｌｌｓ ,ＥＣ)释放内皮依赖性舒张因子 (ＥＤＲＦ) ,对…     

不同剂量白酒对大鼠血管内皮功能、血脂和血糖的影响

目的探讨不同剂量白酒对大鼠血管内皮功能、血脂和血糖的影响。方法将60只雄性SD大鼠随机分成大剂量组（A组）、中剂量组（B组）、小剂量组（C组）和对照组（D组）。酒精灌胃建立动物模型,8周后测定动脉血中NO、血管紧张素Ⅱ（AngⅡ）、TC、TG、HDL-C、LDL-C及血糖的含量和一氧化氮合酶（NOS）、内皮型一氧化氮合酶（eNOS）、诱生型一氧化氮合酶（iNOS）活性。结果A、B与D组相比,NO、NOS、eNOS、AngⅡ、TC、血糖改变差异有统计学意义（P〈0．05）,C、D组相比,上述指标改变无统计学意义（P〉0．05）;A、B、C组与D组相比,HDL—C改变差异有统计学意义（P〈0．05）;A组与B、C、D组相比,iNOS改变差异有统计学意义（P〈0．05）。结论小剂量白酒灌胃对大鼠血管内皮细胞功能有保护作用,能升高大鼠血清HDL-C;大中剂量白酒灌胃对大鼠血管内皮细胞功能有损害作用,对血脂有影响,同时血糖升高,并呈明显的量效关系。不同剂量白酒对血管内皮细胞的作用机制与NOS（包括eNOS和iNOS）活性变化有关。     

急性肺栓塞大鼠血清血管紧张素转换酶1的变化

目的探讨急性肺栓塞大鼠血清血管紧张素转换酶1的变化。方法雄性SD大鼠24只,随机分为对照组,栓塞后24 h组,栓塞后1周组,每组8只;以明胶海绵溶液经颈静脉注入制备大鼠肺栓塞模型,对照组注入同等体积生理盐水。3组大鼠分别于1周(对照组)、栓塞后24 h、栓塞后1周时处死。经右心导管测定肺动脉压、心率、呼吸频率,取动脉血行动脉血气分析及血清血管紧张素转换酶1活性测定;取肺组织制备病理切片,HE染色光镜下观察肺动脉栓塞情况。结果对照组,栓塞24 h组,栓塞1周组大鼠肺动脉平均压分别为(14.2±4.1)mm Hg(1 mm Hg=0.133 kPa)(、26.1±7.5)mm Hg(、26.1±6.8)mm Hg(P<0.05);动脉血氧分压分别为(94.1±8.8)mm Hg(、80.5±5.8)mm Hg(、80.4±13.8)mm Hg(P<0.05);3组大鼠血清血管紧张素转换酶1分别为(30.5±7.2)U/L(、53.5±15.9)U/L(、45.8±17.4)U/L(P<0.05)。光镜下观察,栓塞后24 h组肺组织切片均可见多个肺动脉管腔内海绵明胶栓塞,有继发红血栓形成,肺组织充血、水肿、炎性细胞浸润;栓塞后1周组大鼠部分肺动脉管腔内海绵明胶溶解。结论急性肺栓塞大鼠肺动脉压升高的同时,血清血管紧张素转换酶1明显升高,其程度可能与肺血管床阻塞的范围或程度有关。     

急性肺栓塞患者治疗前后肺血管阻力变化及其临床意义

目的探讨肺血管阻力(PVR)变化在评价急性肺栓塞(APE)患者治疗效果中的临床应用价值。方法回顾性分析30例APE患者治疗前后肺血管阻力变化并探讨其临床意义。结果 PVR在肺栓塞治疗前明显升高,治疗后2周、一月、三月、六月的PVR值与治疗前比较,降低明显,差异有统计学意义;其肺泡-动脉血氧分压[P(A-a)DO2]、PaO2值在治疗后2周、一月、三月、六月与治疗前比较,差异有统计学意义。结论超声心动图测定肺血管阻力结合动脉血气分析是APE治疗效果的良好识别指标。     

急性肺栓塞患者严重程度指数与血清钠水平分析

目的分析急性肺栓塞(APE)患者肺栓塞严重程度指数(PESI)与血清钠水平的病情评估价值和关系。方法回顾性分析经CT肺动脉造影确诊的APE患者临床资料。结果 22例患者入选,PESI低危组均为低危APE,PESI中、高危组的中、高危APE发生率为66.67%,与PESI低危组比较差异显著;共6(27.27%)例APE患者出现低钠血症,其中2(33.33%)例在诊断一月内死亡,低钠血症组和非低钠血症组中、高危APE发生率比较无显著性差异;APE患者血清钠水平与PESI相关系数为-0.318(P=0.149)。结论PESI而非低钠血症对APE病情严重性具有指导价值,合并低钠血症的APE患者一月内死亡率高。     

Diagnosis and treatment of acute pulmonary embolism

Novelties include the introduction of sPESI, a simplified index of pulmonary embolism severity, and hs-cTnT as a new biomarker, already in use in clinical practice.Another novelty is the term unstable pulmonary embolism characterized by either the presence of cardiogenic shock or the need for ventilatory support.The main new information is the evidence of a large US study of treatment of unstable pulmonary embolism reporting a 67% reduction in overall mortality of unstable patients when treated with thrombolytic treatment when compared with the anticoagulation in the same unstable patients.The reduction was obtained across all age groups as well as in comorbid patients.Results of the above study clearly show that, in the absence of absolute contraindications, all unstable APE patients, including the elderly and comorbid patients, should be treated with thrombolysis.By contrast, the comparison of thrombolytic and anticoagulation therapy in the treatment of submassive pulmonary embolism in the PEITHO trial provided unconvincing results, perhaps because of the low mortality rates of the whole group of 1004 patients.Also reported are data from a US study of embolectomies. Caval filter insertion reduced the mortality rates in all analyzed groups. Based on the facts, it is believed another appropriate indication is that of temporary caval filter insertion in patients with severe massive APE, in whom recurrence of pulmonary embolism from pelvic veins has not been ruled out by CT venography.Hemodynamically stable patients should be treated with LMWH or unfractionated heparins, or rivaroxaban or apixaban.At the end of hospitalization a control echocardiography and calculation of residual pulmonary vascular obstruction on a perfusion scan should be performed.     

急性肺栓塞的心电图变化

目的 　 探讨心电图在诊断急性肺栓塞中的作用。　方法　回顾性分析近两年收治的 13例急性肺栓塞患者入院时、溶栓后及治疗 2～ 4周后心电图的变化。　结果　 (1)入院时心电图变化 :心动过速 8例 ,右束支阻滞 3例 ,V1 导联T波、V1 ～V2 导联T波、V1 ～V3导联T波、V1 ～V4 导联T波、V1 ～V5导联T波、V1 ～V6 导联T波倒置为 10、 6、 4、 3、 2和 1例 ,SⅠ >0 1mV、TⅢ 、QⅢ 、SⅠQⅢTⅢ 分别为 7、 7、 9和 7例 ;(2 )溶栓后心电图变化 :心动过速消失 7例 ,右束支阻滞消失 1例 ,胸前导联T波倒置加深 4例 ,SⅠ 变浅 ,QⅢ 减小或消失 ,TⅢ 倒置变浅或直立 3～ 4例 :(3)治疗 2～ 4周后心电图变化 :心动过速消失 ;胸前导联T波直立数增加 ,ST段回基线 ,QⅢ 进一步减小或消失 ,TⅢ 倒置变浅或直立。　结论　急性肺栓塞心电图变化是多变的 ,需动态观察并密切结合临床加以识别。     

The vascular endothelium masks the persistent inhibition of rat thoracic arterial tone induced by S-nitrosoglutathione

Aim

In endothelium-denuded arteries, the nitric oxide (NO) donor S-nitrosoglutathione (GSNO) induced a persistent hypo-reactivity to vasoconstrictors, and low-molecular weight thiols such as N-acetyl cysteine (NAC) produced a relaxant effect. These effects were attributed to the formation of vascular NO stores. In arteries with a functional endothelium, such long-lasting effects on arterial tone have not been well characterised. In this study, we proposed to examine the possibility of storing exogenous NO when the vascular endothelium is still able to produce its own NO.

Methods

For this purpose, changes in isometric tension of isolated arteries were assessed in organ chambers, and nitrosothiol formation was characterised by confocal microscopy.

Results

In rat aortic rings with endothelium pre-exposed to GSNO, the contractile response to norepinephrine (NE) was not attenuated in comparison with control rings, but NAC induced a relaxant effect. However, an attenuation of the response to NE was observed in GSNO-exposed, intact aortic rings after inhibition of NO synthase by N^w-nitro-L-arginine methylester (L-NAME) or in GSNO-denuded rings.The relaxing effects of NAC were due to the mobilisation of NO from nitrosothiols after nitrosylation of protein SH residues. Moreover, the hypo-reactivity to NE and the relaxant effect of NAC were abolished by 1H-[1,2,4] oxadiazolo(4,3-a)quinoxalin-1-one (ODQ), an inhibitor of soluble guanylyl cyclase, and partially by the K⁺-sensitive channel inhibitor tetra-ethyl-ammonium (TEA).

Conclusion

These data show that endothelium-derived NO masked the persistent effect of GSNO in rat thoracic aorta. However, the ability of GSNO to form releasable NO stores without altering the vascular tone can be particularly useful in preventing endothelial dysfunction in which NO formation decreases.     

急性肺栓塞不同危险分层与心电变化的关系

目的探究急性肺栓塞不同危险分层与心电变化的关系。方法选取2016年1月至2019年1月急性肺栓塞患者90例,根据危险分层进行分组。其中,低危组35例,中危组30例,高危组25例。均行心电图及动态心电图检查,心电图观察指标为心率、P波、QRS波群、T波、ST段变化,动态心电图观察指标心率变异性及心律失常。结果高危组窦性心动过速、肺型P波、SⅠQⅢTⅢ、ⅢST段抬高、V1ST段抬高、V1~V4T波倒置发生率均高于低危组,高危组ⅢST段抬高、V1ST段抬高、V1~V4T波倒置发生率高于中危组,差异均有统计学意义(均P<0.05)。高危组心率变异性指标正常RR间期标准差(SDNN)、每5min正常RR间期平均值的标准差SDANN均低于中、低危组,差异有统计学意义(均P<0.05)。高危组患者室性心律失常、室上性心律失常、房室传导阻滞及束支传导阻滞阳性率均高于中危组和低危组,差异均有统计学意义(均P<0.05)。结论急性肺栓塞时心电图改变与危险分层相关。     

Red blood cell transfusion and outcomes in acute pulmonary embolism

Background and objective

Blood transfusion has been associated with adverse outcomes in certain conditions. This study investigates the prevalence and outcomes of red blood cell (RBC) transfusion in patients with acute pulmonary embolism (PE).

Methods

Retrospective study of consecutive patients from 2000 to 2012 admitted to a tertiary hospital with a primary diagnosis of acute PE. Transfusion status during the hospital admission was ascertained. Mortality was tracked from a state‐wide death database and analysed using multivariable modelling.

Results

A total of 73 patients (5% of all patients admitted with PE) received RBC transfusion during their admission. These patients were significantly older, had more co‐morbidities, worse haemodynamics, higher simplified pulmonary embolism severity index scores, and lower plasma sodium and haemoglobin (Hb) levels at admission. Unadjusted mortality for the transfused group was significantly higher at 30‐day (19% vs 4%, P < 0.001) and 6‐month (40% vs 10%, P < 0.001) follow‐up. Multivariable modelling showed RBC transfusion to be a significant independent predictor of mortality at 30‐day (odds ratio 3.06, 95% CI: 1.17–8.01, P = 0.02) and 6‐month (hazard ratio (HR) 1.97, 95% CI: 1.12–3.46, P = 0.02). Sensitivity analysis confirmed that transfused patients had higher mortality than non‐transfused patients in the subgroup of patients with Hb <100 g/L.

Conclusion

RBC transfusion in patients hospitalized with acute PE is rare and appears to be associated with increased risk of short‐ and long‐term mortality, independent of Hb level on admission. This finding underscores the need for future randomized controlled studies on the impact of RBC transfusion in the management of patients admitted with acute PE. [Correction added on 4 May 2018, after first online publication: the word ‘serum’ was changed to ‘plasma’ throughout the article where appropriate.]

     

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。     

Treatment options and strategies for acute severe pulmonary embolism

Pulmonary thromboembolism (PE) is the third most frequent cause of cardiovascular death after ischaemic heart disease and stroke. In fatal PE, 2/3 of patients die within first hour of presentation. There is a clinical impetus to rapidly recognize, risk-stratify and appropriately treat patients with acute severe PE. Current recommendations present conflicting classification systems, and there is often some confusion in the clinical evaluation and management of patients with acute severe PE. This review presents a series of real clinical cases, which illustrate the available treatment options, ranging from conservative therapy to thrombolysis through to percutaneous catheter fragmentation and open surgical embolectomy. We evaluate the evidence for the various strategies and propose an algorithm for clinicians with a focus on early risk stratification and timely referral. This is particularly relevant to regional and remote centres, as well as secondary and tertiary institutions.