急性肺栓塞患者右室功能不全与肺血流灌注的相关性

目的观察血压正常的急性肺栓塞患者右室超声心动指标与肺血管阻塞严重程度相关性及治疗有效性的预测价值。方法回顾我院6年间收治的56例血压正常的急性肺栓塞患者的临床资料,分析其超声心动图所测得的右室收缩末期及舒张末期面积与肺灌注扫描灌注缺损数和增强螺旋CT所代表的肺血管阻塞之间的相关性。结果与正常对照相比,肺栓塞患者右室舒张末面积和收缩末面积增大,且与肺灌注缺损数呈正相关（r=0.76,P<0.01;r=0.77,P<0.01）,而舒张与收缩末面积的变化率则降低,与肺灌注缺损数呈负相关（r=-0.44,P<0.01）。增强CT显示血管阻塞越广泛,收缩末面积越大（P<0.05）,舒张与收缩末面积的变化率越小（P<0.05）。治疗有效时,肺灌注缺损数随右室功能的好转而降低。结论血压稳定的急性肺栓塞患者右室功能的异常程度与肺血管的阻塞程度密切相关,右室功能的检查可用于观察肺灌注情况以及治疗有效情况的相关指标。

Association between right ventricular dysfunction and pulmonary perfusion in hemodynamically stable patients with acute pulmonary embolism

AIM To assess the value of right ventricular abnormalities in predicting the severity of pulmonary vascular obstruction and the efficacy of treatment in hemodynamically stable patients following acute pulmonary embolism.METHODS Fifty-six hemodynamically stable patients presenting with acute pulmonary embolism were retrospectively reviewed.The correlation between the right ventricular end-diastolic and end-systolic area and the pulmonary vascular obstruction quantified by lung scan and contrast-enhanced spiral computed tomographic scanning was determined.RESULTS Compared with that in control subjects,the mean right ventricular end-diastolic and end-systolic areas increased,but the fractional right ventricular area reduced in patients.The extent of right ventricular end-diastolic and end-systolic area enlargement and the decrease in fractional area were correlated with the perfusion defect score and the degree of pulmonary vascular obstruction detected by contrast-enhanced spiral computed tomographic scanning.CONCLUSION The extent of right ventricular dysfunction in hemodynamically stable patients following acute pulmonary embolism reflects the degree of pulmonary vascular obstruction,and its improvement is a determinant index for the effective treatment.