肺灌注缺损百分数在急性肺栓塞危险分层中的价值探讨

目的 探讨肺灌注缺损百分数（PPDS％）对急性肺栓塞（APE）患者危险分层及预后判断的临床价值。方法根据2008ESC指南标准回顾分析2000年1月至2008年12月本院21例APE患者（A组）中低危10例、中危7例、高危4例的PPDS％，按此确定PPDS％对APE危险分层的参考值（PPDS％标准）。依据PPDS％标准对2009年1月至2011年6月本院34例APE患者（B组）进行危险分层，研究其临床不良事件发生率。结果A组中低危、中危、高危APE患者的PPDS％分别为（25．94±3．95）％、（45．63±4．38）％、（58．42±4．96）％（t34．755，P〈0．01）；B组34例APE患者按PPDS％标准分为低危17例、中危11例、高危6例，依据ESC指南分级为低危15例、中危13例、高危6例，二者的分级一致率为94．11％（32／34），其中高危患者的分级一致率为100．0％（6／6）。B组低危、中危、高危患者（依据PPDS％标准）分别有1例（5．89％）、3例（27．27％）、4例（66．67％）发生I临床不良事件，差异有统计学意义（x2=9．23，P〈0．01）。结论PPDS％可作为APE危险分层的重要参考指标，对指导临床决策及预后判断有重要价值。

Application value of percentage of pulmonary perfusion defect scores in predicting risk stratification of acute pulmonary embolism

Objective To investigate the clinical value of percentage of pulmonary perfusion defect score ( PPDs％ ) for risk stratification and prognosis evaluation in patients with acute pulmonary embolism (APE).Methods A retrospective study was carried out on PPDs％ data of patients( n =21 ) with confirmed APE from January 2001 to December 2008.The patients were divided into three levels,low( n =10),medial( n =7) and high risk groups( n =4),according to 2008 ESC APE diagnosis and treatment guidelines.The reference index in predicting risk stratification by PPDs％ was ascertained.34 patients with confirmed APE were divided into three levels ( mild,moderate and severe risk levels) according to the standard of PPDS％ diagnosis from January 2009 to June 2011.A prospective study on the incidence rate of the clinical adverse events was performed.Results The PPDs％ of low,medial and high risk levels according to 2008 ESC guidelines were (25.94 ± 3.95 ) ％,(45.63 ± 4.38 ) ％ and ( 58.42 ± 4.96 ) ％ respectively,with a significant difference ( t ≥4.755,P ＜ 0.01 ).The standard of PPDS％ diagnosis for risk stratification was confirmed in APE:low risk levels:PPDs％ ＜ 30％,moderate:30％ ≤ PPDs％ ＜50％,and high:PPDs％ ≥50％.The mild,moderate and severe risk patients with APE were 17cases,11cases and 6cases respectively,according to the standard of PPDs％ diagnosis,or 15cases,13cases and 6cases respectiveldy,according to the standard of 2008 ESC guidelines.The uniform rate was 94.11％ for two methods; the uniform rate was 100.00％ in which high risk of APE.The mild,moderate and severe risk patients with APE according to the standard of PPDs％ standard with clinical adverse events for were 1case (5.89％ ),3cases (27.27％ ) and 4cases (66.67％ ) respectively,with a significant difference ( x2 =9.23,P ＜0.01 ).Conclusions PPDs％ could be used as an important reference index for risk stratification of diagnosis,selecting therapeutic programs,evaluating therapeutic efficiency and predicting the prognosis in patients with APE.