超声心动图对急性肺栓塞患者预后的预测价值研究

摘要

Objective To investigate the predictive value of echocardiography on prognosis in patients with acute pul-monary embolism(APE). Methods From January 2005 to March 2009,a total of 63 patients with APE underwent echocardio-graphy in our hospital were selected,and then their medical history and examination results of echocardiography were retrospec-tively analyzed. According to the occurrence of right ventricular dysfunction(RVD),they were divided into RVD group(n =22)and non - RVD group(n = 41);according to the ratio of right ventricular end - diastolic diameter(RVED)and left ven-tricular end - diastolic diameter(LVED),they were divided into RVED/ LVED≥0. 65 group(n = 19)and RVED/ LVED <0. 65 group(n = 44). Fatality rate during hospitalization,incidence of adverse events during hospitalization and fatality rate during 3 - month fellow - up were compared in each group. Results There was no significant differences of fatality rate during hospitalization between RVD group and non - RVD group(P > 0. 05);incidence of adverse events during hospitalization and fa-tality rate during 3 - month fellow - up of RVD group were higher than those of non - RVD group(P < 0. 05). Fatality rate dur-ing hospitalization,incidence of adverse events during hospitalization and fatality rate during 3 - month fellow - up of RVED/LVED≥0. 65 group were higher than those of RVED/ LVED < 0. 65 group( P < 0. 05);ROC curve showed that,the best threshold of RVED/ LVED for predicting death during hospitalization in patients with APE was 0. 73,while the sensitivity was 71. 4% ,specificity was 91. 1% . Conclusion APE patients with RVD and(or)RVED/ LVED≥0. 65(especially ≥0. 73) have a higher fatality rate during hospitalization,higher incidence of adverse events during hospitalization and higher fatality rate during 3 - month fellow - up,echocardiography has a certain predictive value on prognosis in patients with APE.%目的：探讨超声心动图对急性肺栓塞（APE）患者预后的预测价值。方法选择我院2005年1月-2009年3月收治的行超声心动图检查的 APE 患者63例，回顾性分析其病历资料及超声心动图检查结果，根据右室功能障碍（RVD）发生情况分为 RVD 组22例与非 RVD 组41例；根据右室舒张末直径与左室舒张末直径比值（RVED/LVED）分为 RVED/ LVED≥0.65组19例与 RVED/ LVED <0.65组44例。比较各组住院期间病死率、住院期间不良事件发生率及随访3个月病死率。结果 RVD 组与非 RVD 组住院期间病死率比较，差异无统计学意义（ P >0.05）；RVD 组住院不良事件发生率、随访3个月病死率均高于非 RVD 组（P <0.05）。RVED/ LVED≥0.65组住院期间病死率、住院期间不良事件发生率、随访3个月病死率均高于 RVED/ LVED <0.65组（ P <0.05）；绘制 ROC 曲线发现， RVED/ LVED 预测 APE 患者住院期间死亡的最佳临界值为0.73，取最佳临界值时其灵敏度为71.4%，特异度为91.1%。结论存在 RVD 和/或 RVED/ LVED≥0.65（尤其是≥0.73）的 APE 患者住院期间病死率、住院期间不良事件发生率及随访3个月病死率较高，超声心动图对 APE 患者预后有较高的预测价值。