超声心动图联合外周血管超声对肺血栓栓塞症的诊断价值

摘要

Objective To evaluate the diagnostic value of deep venous thrombosis(DVT)on lowerlimb venous ultrasonography combined with right ventricular dysfunction (RVD) on transthoracic echocardiography(TTE) in patients with acute pulmonary thrombo embolism(PTE). Methods This prospective multicenter control trial included 520 patients with confirmed acute PTE from 41 hospitals between June 2002 and February 2005.Results The incidence of RVD and DVT was associated with the severity of PTE.There were 57.0%(207/363)patients with RVD,49.6%(1 80/363)patients with DVT,265(73.0%)patients with RVD and/or DVT,and 121(33.3%)patients with combined sign of DVT plus RVD in the whole population.As to major PTE population,206(99.5%)patients had RVD and 121 (58.5%)patients had DVT.In addition,the rate of RVD was much greater in proximal PTE than in lobar PTE and segmental PTE(78.7%,51.4%and 21.7%,respectively,P＜0.001).DVT occurred more frequently in proximal PTE than in lobar PTE and segmental PTE(61.7%,46.8%and 37.0%,respectively,P＜O.001).The incidence of the combined sign was 51.1%,24.3%and 8.7%,respenctively (P＜0.001).Conclusions The incidence of the combined sign of RVD plus DVT was associated with the severity of PTE and the localization of emboli.The combined sign of RVD plus DVT help diagnose major PTE especially in emergency department.%目的 联合应用超声心动图(TTE)和外周血管超声评价右心功能不全(RVD)和下肢深静脉血栓(DVT)对肺血栓栓塞症(PTE)的诊断价值.方法 研究对象为全国41家医院的520例确诊为急性PTE的住院患者.结果 56.0%的患者伴RVD,49.1%存在DVT.363例资料完整患者57.0%有RVD,49.6%伴DVT;伴RVD和(或)DVT者中,33.3%RVD、DVT均阳性.而其中207例(次)大面积PTE,99.5%有RVD,58.5%伴DVT.RVD在近端肺动脉PTE中阳性率(78.9%)明显高于叶肺动脉PTE(51.4%)和段肺动脉PTE(21.7%),DVT阳性率分别为61.7%、46.8%、37.0%,RVD+DVT阳性率分别为51.1%、24.3%和8.7%.结论 RVD/DVT阳性率与PTE严重程度及解剖部位有关,联合TTE和外周血管超声可提高超声技术在急性PTE尤其在(次)大面积PTE、近端肺动脉PTE中的诊断价值.