CT肺动脉造影诊断急性肺栓塞伴右心功能不全

摘要

目的 探讨CT肺动脉造影(CTPA)诊断急性肺栓塞伴右心功能不全(RVD)的价值.方法 收集2009年3月-2010年1月经CTPA确诊并于48 h内接受超声心动图检查的肺栓塞患者47例(肺栓塞组),随机抽取47名同期CTPA检查结果阴性患者作为对照(对照组),参考超声心动图检查结果,分析CTPA评价肺栓塞伴右心功能不全的诊断准确性.结果 肺栓塞组右心室最大短轴直径与右心室最大横截面积均大于对照组(P均＜0.05).在47例肺栓塞患者中,以超声心动图结果为标准,CTPA诊断右心扩大的敏感度为70.59％(12/17),特异度为90.00％(27/30),Kappa指数为0.622.中央型肺栓塞患者右心室最大横截面积大于周围型肺栓塞患者(P=0.035).结论 CTPA可在准确诊断肺栓塞的同时判定患者是否伴有右心室扩大及右心功能不全,为判断肺栓塞的危险因子及评估肺栓塞早期死亡危险分级提供可靠依据.%Objective To evaluate the role of CT pulmonary angiography (CTPA) in detecting right ventricular dysfunction (RVD) in patients with acute pulmonary embolism (APE). Methods From Mar 2009 to Jan 2010, 47 patients diagnosed as pulmonary embolism (PE group) by CTPA underwent ultrasound cardiogram (UCG) within 48 h. Forty-seven subjects with negative CTPA results were randomly selected at the same time and enrolled as the control group. The value for CTPA in diagnosing RVD caused by PE was analyzed according to UCG results. Results The maximum cross diameter and maximum area of right ventricular in PE group were bigger than those of control group (both P<0. 05). Taking UCG as standard, the sensitivity and specificity of CTPA in diagnosing right ventricle enlargement was 70. 59% (12/17) and 90. 00% (27/30) , respectively, the Kappa value was 0. 622. The maximum area of right ventricular in the central type PE patients was larger than peripheral PE (P = 0. 035). Conclusion CTPA can not only diagnose PE accurately, but also diagnose whether PE patients combining with right ventricular dilatation and right ventricular dysfunction. Therefore it can provide a reliable basis for assessment of the risk factors for PE, as well as constitute an important step in risk stratification in PE patients with RVD.