多层螺旋 CT 肺动脉造影对肺栓塞严重程度的诊断价值

摘要

Objective To investigate the value of multislice spiral CT pulmonary angiography ( CTPA) in diagnosis of the severe degree of patients with pulmonary embolism ( PE) .Methods From May 2010 to May 2014, 72 PE patients were enrolled, and in the same time, non PE patients of 36 cases were enrolled as the control group, all the patients with PE were examined by CTPA and Qanadli score.According to Qanadli score, pulmonary embolism index were calculated, and the PE patients were divided into 3 groups, pulmonary embolism index <50%as group A ( n =30) , from 50%to 80%as group B ( n =23), >80%as group C ( n =19).Right ventricular short axis maximum diameter (RV), left ventricular short axis maximum diameter ( LV) , right /left ventricular short axis diameter ratio ( RV/LV) , the largest diameter of pulmonary artery and superior vena cava diameter were compared among the 4 groups;analyzed the correlation between the pulmonary embolism index and systolic blood pressure.Results Group A’ s LV, RV, RV/LV, superior vena cava diameter were higher than that of control group ( P <0.05);RV, RV/LV, diameter of pulmonary artery were lower than those of group B, and the diffe-rence was statistically significant ( P <0.05);group B’s RV/LV, pulmonary artery diameters were lower than that in group C, and the difference was statistically significant ( P <0.05).Pulmonary embolism index: group A was (50.12 ± 19.47)%, group B was (52.37 ±20.11)%, group C was (52.90 ±21.17)%; systolic blood pressure: group A was (93.12 ±16.44) mm Hg, group B was (92.41 ±17.44) mm Hg, group C was (91.34 ±16.22) mm Hg, pulmonary em-bolism index and systolic blood pressure were negatively correlated ( r =-0.758, P <0.01).Conclusion CTPA parame-ters ( LV, RV, RV/LV, diameter of pulmonary artery, superior vena cava diameter) in patients with PE can be used to evalu-ate pulmonary embolism severity index, pulmonary embolism index and systolic blood pressure were negatively correlated, CT-PA has better clinical value in the diagnosis of PE.%目的：探讨多层螺旋CT肺动脉造影（CTPA）对肺栓塞（PE）患者严重程度的诊断价值。方法收集2010年5月—2014年5月确诊的PE患者72例，并纳入同期非PE患者36例作为对照组，2组患者均进行CTPA检查及Qanadli评分。根据Qanadli评分计算肺栓塞指数并将PE患者分为3组，肺栓塞指数＜50％为A组（ n ＝30），50％～80％为B组（ n ＝23），＞80％为C组（ n ＝19）。比较4组右心室短轴最大径（RV）、左心室短轴最大径（LV）、右／左心室短轴最大径比（ RV／LV）、肺动脉直径和上腔静脉直径；分析肺栓塞指数与动脉收缩压的相关性。结果 A组的LV、RV、RV／LV、上腔静脉直径均高于对照组（ P均＜0�．05）；RV、RV／LV、肺动脉直径均低于B组，且差异有统计学意义（ P均＜0．05）；B组的RV／LV、肺动脉直径均低于C组，且差异有统计学意义（ P均＜0．05），余指标各组间无显著差异（ P ＞0．05）。肺栓塞指数：A组（50．12±19．47）％，B组（52．37±20．11）％，C组（52．90±21．17）％；动脉收缩压：A组（93．12±16．44） mm Hg，B组：（92．41±17．44） mm Hg，C组（91．34±16．22） mm Hg，肺栓塞指数与动脉收缩压呈负相关（ r ＝－0．758， P ＜0．01）。结论 PE患者的CTPA参数（ LV、RV、RV／LV、肺动脉直径、上腔静脉直径）可以作为评估肺栓塞严重程度的指标，且肺栓塞指数与动脉收缩压呈负相关性，CTPA在PE的诊断中具有较好的临床价值。