超声心动图联合脑钠肽检测评价急性肺栓塞溶栓治疗效果

目的 探讨超声心动图联合血浆脑钠肽(brain natriuretic peptide,BNP)检测在急性肺栓塞(acute pulmonary embolism,APE)溶栓治疗中的价值.方法 确诊APE且超声提示有右心压力超负荷征象患者31例进行溶栓治疗,分别在溶栓前和溶栓后24～48 h行超声、肺通气-灌注显像检查及BNP检测.结果 26例溶栓有效,溶栓后其肺动脉收缩压由(57.3±18.2)mm Hg降至(40.4±15.4)mm Hg(P=0.003),右室舒张末径由(40.6±6.1)mm减小为(35.4±6.0)mm(P＜0.01),肺动脉内径由(27.2±4.9)mm减小为(22.5±4.4)mm(P=0.004),左室舒张末径由(42.4±7.2)mm增加为(43.1±6.9)mm(P=0.42),室间隔矛盾运动者由20例减少为10例,血浆BNP由(278.8±43.3)ng/L下降为(119.1±40.4)ng/L(P=0.000 01).5例溶栓无效,溶栓前后超声心动图各参数无明显变化,但血浆BNP由(431.8±57.7)ng/L增加为(496.4±70.3)ng/L(P=0.03).血浆BNP水平与肺动脉收缩压有较好相关关系(r=0.62,P＜0.01).结论 溶栓治疗能迅速改善APE患者的肺灌注和右心功能.超声联合BNP水平检测可敏感地反映溶栓治疗中的血流动力学变化,准确评价疗效.

Abstract：

Objective To explore the value of combined echocardiography and brain natriuretic peptide (BNP) levels in acute pulmonary embolism (APE) treated by thrombolysis.Methods Echocardiography,pulmonary ventilation-perfusion imaging and plasma BNP levels were performed before thrombolysis and 24 - 48 h after thrombolysis in 31 patients with diagnosis of APE and signs of right ventricular pressure overload.Results Twenty-six patients with thrombolysis effective,after thrombolysis,the pulmonary artery systolic pressure decreased from (57.3 ± 18.2)mm Hg to (40.4 ± 15.4)mm Hg (P= 0.003) ,the right ventricular diastolic diameter reduced from (40.6 ± 6.1)mm to (35.4 ± 6.0)mm (P ＜0.01) ,the pulmonary artery diameter reduced from (27.2 ± 4.9)mm to (22.5 ± 4.4)mm (P = 0.004) ,the left ventricular diastolic diameter increased from (42.4 ± 7.2)mm to (43.1 ± 6.9)mm (P = 0.42),septal contradiction were reduced from 20 cases to 10 cases (P = 0.02),plasma BNP levels decreased from (278.8 ± 43.3)ng/L to (119.1 ± 40.4)ng/L (P = 0.000 01).Five patients with thrombolysis ineffective,there were no significant changes before and after thrombolytic therapy in the parameters of echocardiography,however,plasma BNP levels increased from (431.8 ± 57.7) ng/L to (496.4 ± 70.3) ng/L(P = 0.03).Plasma BNP levels and pulmonary artery systolic pressure had a better relationship(r = 0.62,P ＜0.01).Conclusions The pulmonary perfusion and right ventricular function in patients with APE can be rapidly improved by thrombolytic therapy.Combined echocardiography and the BNP levels is a sensitive index in the hemodynamic changes of thrombolytic therapy,and can evaluate the treatment accurately.

Value of combined echocardiography and brain natriuretic peptide levels in acute pulmonary embolism treated by thrombolysis

Objective To explore the value of combined echocardiography and brain natriuretic peptide (BNP) levels in acute pulmonary embolism (APE) treated by thrombolysis.Methods Echocardiography,pulmonary ventilation-perfusion imaging and plasma BNP levels were performed before thrombolysis and 24 - 48 h after thrombolysis in 31 patients with diagnosis of APE and signs of right ventricular pressure overload.Results Twenty-six patients with thrombolysis effective,after thrombolysis,the pulmonary artery systolic pressure decreased from (57.3 ± 18.2)mm Hg to (40.4 ± 15.4)mm Hg (P= 0.003) ,the right ventricular diastolic diameter reduced from (40.6 ± 6.1)mm to (35.4 ± 6.0)mm (P ＜0.01) ,the pulmonary artery diameter reduced from (27.2 ± 4.9)mm to (22.5 ± 4.4)mm (P = 0.004) ,the left ventricular diastolic diameter increased from (42.4 ± 7.2)mm to (43.1 ± 6.9)mm (P = 0.42),septal contradiction were reduced from 20 cases to 10 cases (P = 0.02),plasma BNP levels decreased from (278.8 ± 43.3)ng/L to (119.1 ± 40.4)ng/L (P = 0.000 01).Five patients with thrombolysis ineffective,there were no significant changes before and after thrombolytic therapy in the parameters of echocardiography,however,plasma BNP levels increased from (431.8 ± 57.7) ng/L to (496.4 ± 70.3) ng/L(P = 0.03).Plasma BNP levels and pulmonary artery systolic pressure had a better relationship(r = 0.62,P ＜0.01).Conclusions The pulmonary perfusion and right ventricular function in patients with APE can be rapidly improved by thrombolytic therapy.Combined echocardiography and the BNP levels is a sensitive index in the hemodynamic changes of thrombolytic therapy,and can evaluate the treatment accurately.