超声心动图急性肺栓塞溶栓治疗的评估

目的应用超声心动图技术观察急性肺栓塞患者溶栓抗凝治疗前后肺动脉栓子、右心结构及收缩功能的改变。方法前瞻性非随机对照研究,对2002年12月至2006年4月间经肺动脉CT或肺血管造影证实的30例急性肺栓塞患者行溶栓治疗,应用经胸超声心动图观察治疗前、治疗后24～30h、1个月的肺动脉栓子、主肺动脉及其分支内径、右房室内径,右室前壁运动幅度、右室舒张末期容积、右室射血分数,三尖瓣返流、肺动脉收缩压等指标。结果30例急性肺动脉栓塞患者溶栓治疗24～30h后右房室结构明显改善,表现为右房长径及横径、右室前后径及横径、主肺及右肺动脉内径、右室舒张末期容积与治疗前比较明显回缩(P<0.01),右室前壁运动幅度、右室射血分数有所增加(P<0.01),肺动脉收缩压明显下降(P<0.01);治疗后1个月后右房室大小、主肺及右肺动脉内径、右室舒张末期容积、右室前壁运动幅度及肺动脉收缩压等仍有恢复(P<0.05或P<0.01)。5例患者主肺动脉和/或右、左肺动脉内检出栓子,溶栓后栓子逐渐消失。结论超声心动图可动态、实时、无创评价急性肺动脉栓塞溶栓治疗效果,尤对血栓的溶解、右房室结构、右室超负荷及肺动脉高压的变化有独到的价值。

Cardiographic assessment following thrombolysis for acute pulmonary embolism

Objective To evaluate the cardiographic changes following thrombolysis and anticoagulation for acute pulmonary (embolism with embolus of pulmonary artery and structures and functions of right atrium ventricular. Method Thirty patients with acute pulmonary embolism, confirmed by computed tomographic angiography or angiography of pulmonary artery, were enrolled in this prospective nonrandomized control study and performed thrombolysis therapy between December 2002 and April 2006. The embolus and inner diameter of pulmonary artery,right atrial diameter, right ventricular diameter, right ventricular anterior wall movement, right ventricular end diastolic volume, right ventricular ejection fraction, tricuspid valvular regurgitation and the systolic pressure of pulmonary artery were observed by using transthoracic echocardiography or bedside echocardiography. Results After twenty to thirty six hours and during a month follow-up after thrombolysis,the right heart morphology was increasingly improved,which presented with shortening of right atrium transversal diameter and left-right diameter of the right ventricles,pulmonary artery inner diameter and right ventricular end diastolic volume(P<0.01),increasing of right ventricular anterior wall movement and right ventricular ejection fraction, reducing of pulmonary artery systolic pressure. The pulmonary artery embolus in 5 of 30 patients had been dissolving after the thrombolysis and anticoagulation therapy for one month. Conclusions Echocardiography had important value in evaluating the effects of thrombolysis acute pulmonary embolism in timing and non-invasive way, especially in probing embolus dissolved, right atrium-ventricular structure, right ventricular over-load and pulmonary hypertension.