心超在评估急性肺栓塞患者预后中的价值

 目的  观察急性肺栓塞(pulmonary embolism,PE)患者的心超表现,评估其在判断PE预后方面的价值及其影响因素。方法  分析2008年1月至2012年12月复旦大学附属中山医院收治的697例经肺动脉造影或通气血流灌注检查的急性PE患者,其中有331病例进行了心超检查,根据检查结果分为2组,即右心功能正常或轻度受损组(normal and mildly impaired right heart function,No RVD组)和急性右心功能不全组(acute right ventricular dysfunction,RVD组)。随访患者6个月的预后情况,并进行相关分析。结果  331例急性PE患者中发生右心功能不全的病例为95例(28.7%),未发生右心功能不全的病例为236例(71.3%)。通过两组患者6个月的随访,发现RVD组不良事件发生率明显高于No RVD组。多因素Logistic回归分析发现心超表现中肺动脉高压(P=0.003,OR=4.13,95% CI：3.00~5.67),肺动脉增宽(P=0.005,OR=4.72,95%CI：2.70~8.26)和右室扩大(P=0.007,OR=163.92,95% CI：65.09~412.79)是评估PE预后不良事件发生的预测因子。结论  心超随访有助于急性PE患者的预后评价,肺动脉高压、肺动脉增宽、右室扩大可能是判断急性PE合并右心功能不全患者不良预后的心超表现。

The value of echocardiography in assessing the prognosis of acute pulmonary embolism patients

Objective  To observe the clinical performance of echocardiography in acute pulmonary embolism (PE) patients,and to evaluate its value and influencing factors in assessing the prognosis of PE patients.Methods  From Jan.2008 to Dec.2012,697 cases were diagnosed as acute PE by pulmonary angiography or ventilation perfusion examination.Among them,331 cases underwent echocardiography were divided into 2 groups,normal or mildly impaired right heart function (No RVD) group,and acute right ventricular dysfunction (RVD) group.The prognosis was obtained  from a 6-month follow-up and correlation analysis was conducted.Results  Of the 331 PE patients,right heart failure was observed in 95 cases (28.7%),the left 236 cases (71.3%) were normal or had mildly right ventricular dysfunction.In the 6-month follow-up investigation,RVD group had significantly higher adverse clinical incidence than that of No RVD group.Multifactor Logistic analysis indicated that echocardiography performance including pulmonary hypertension (P=0.003,OR= 4.13,95% CI:3.00-5.67),dilated pulmonary artery (P=0.005,OR=4.72,95%CI:2.70-8.26) and right ventricular dilatation (P=0.007,OR=163.92,95% CI:65.09-412.79) were predictive factors of adverse events in PE prognosis.Conclusions  Echocardiography was effective for prognostic evaluation in patients with acute PE.Pulmonary hypertension,dilated pulmonary artery and ventricular dilatation were the performance of harmful prognosis in acute PE patients with RVD.