急慢性肺栓塞心电图及超声心动图的对比

目的：了解在急慢性肺栓塞中常规十二导联心电图及超声心动图的表现及其不同之处。方法：回顾性研究从2001年1月到2007年3月53例住院肺栓塞患者的资料，对象被分为急性肺栓塞组（24例）及慢性肺栓塞组（29例）；分析急、慢性肺栓塞的心电图及超声心动图（包括右房右室大小，肺动脉压力，左房左室大小等）表现。结果：两组病人中绝大多数病人均有心电图的异常，急性组病人更多见SⅠ、QⅢ（P均〈0．05）。而慢性组心房颤动发生率明显高于急性组（P〈0．01），且RⅥ增高，RⅥ〉1．0mV例数增多（P均〈0．05）；两组病人超声心动图表现不同程度的肺动脉压力升高，慢性组右房、室扩大更为明显（P〈0．01，〈0．05）。结论：常规心电图，超声心动图在急慢性肺栓塞中表现不同，具有诊断价值。     

超声心动图评价急、慢性肺栓塞患者右心室重构的研究

目的:探讨超声心动图技术评价急、慢性肺栓塞患者右心室功能及重构的临床价值。方法:选取急性肺栓塞患者30例(急性肺栓塞组)和慢性肺栓塞患者30例(慢性肺栓塞组),另选30例健康者为正常对照组。二维超声测量右心室前壁厚度(RVAWTd);多普勒超声测量三尖瓣反流压力阶差(TRPG)及肺动脉压力(SPAP);实时三维超声心动图(RT-3DE)技术测量各组患者的右心室舒张末期容积(RVEDV)、右心室收缩末期容积(RVESV)及右心室射血分数(RVEF);组织多普勒成像技术(TDI)测量三尖瓣环心肌运动舒张早期峰值速度(Em)、舒张晚期峰值速度(Am)及Em/Am。结果:与正常对照组比较,急性肺栓塞组及慢性肺栓塞组RVAWTd、TRPG、SPAP、RVEDV、RVESV、Am值增大(P<0.01～0.05),Em、Em/Am、RVEF值减小(P<0.01);与急性肺栓塞组比较,慢性肺栓塞组TRPG、SPAP、RVAWTd、RVEDV值均增大(P<0.01～0.05)。结论:急、慢性肺栓塞患者可发生右心室功能变化及形成右心室重构,慢性肺栓塞患者较急性肺栓塞患者更为严重,超声心动图评价肺栓塞患者右心室重构简便、客观、有效。     

急诊床旁超声心动图在急性肺栓塞诊断价值探究

目的对床旁超声心动图在急性肺栓塞诊断中的价值进行探讨。方法抽取2012年1月~2015年1月由我院门诊确诊的46例急性肺栓塞患者的超声心动图资料作为本次研究的研究对象,观察床旁超声心动图是否可以观察到患者肺动脉主干的血栓回声征象、分叉处和右房的血栓回声征象以及右室的血栓回声征象,是否能够观察到患者肺动脉压力升高的间接征象、右室壁活动减弱的间接征象以及右心负荷增加的间接征象等,并对观察结果进行分析和总结。结果 46例患者都有右房室增大的情况发生,患者的肺动脉以及分支内径出现变宽的情况,右室前壁、左室后壁以及室间隔的收缩减弱,但是没有明显异常现象。患者左室、右室以及左房的舒张末期的横径都出现了增加的现象。46例患者都存在三尖瓣反流的现象,重度反流的患者有12例,中度反流的患者有23例,轻度反流的患者有5例,轻微反流的患者有6例。三尖瓣反流的速度为(348.96±79.85)cm/s,肺动脉收缩压的估测结果为(56.02±22.89)mm Hg。结论通过床旁超声心动图可以观察到患者肺动脉主干的血栓回声征象、分叉处和右房的血栓回声征象以及右室的血栓回声征象,并且能够观察到患者肺动脉压力升高的间接征象、右室壁活动减弱的间接征象以及右心负荷增加的间接征象等,利用床旁超声心动图可以对患者是否患有急性肺栓塞的情况进行明确的判定,在临床上具有非常重要的意义。     

急诊床旁超声心动图在急性肺栓塞诊断价值探究

目的对床旁超声心动图在急性肺栓塞诊断中的价值进行探讨。方法抽取2012年1月~2015年1月由我院门诊确诊的46例急性肺栓塞患者的超声心动图资料作为本次研究的研究对象,观察床旁超声心动图是否可以观察到患者肺动脉主干的血栓回声征象、分叉处和右房的血栓回声征象以及右室的血栓回声征象,是否能够观察到患者肺动脉压力升高的间接征象、右室壁活动减弱的间接征象以及右心负荷增加的间接征象等,并对观察结果进行分析和总结。结果 46例患者都有右房室增大的情况发生,患者的肺动脉以及分支内径出现变宽的情况,右室前壁、左室后壁以及室间隔的收缩减弱,但是没有明显异常现象。患者左室、右室以及左房的舒张末期的横径都出现了增加的现象。46例患者都存在三尖瓣反流的现象,重度反流的患者有12例,中度反流的患者有23例,轻度反流的患者有5例,轻微反流的患者有6例。三尖瓣反流的速度为(348.96±79.85)cm/s,肺动脉收缩压的估测结果为(56.02±22.89)mm Hg。结论通过床旁超声心动图可以观察到患者肺动脉主干的血栓回声征象、分叉处和右房的血栓回声征象以及右室的血栓回声征象,并且能够观察到患者肺动脉压力升高的间接征象、右室壁活动减弱的间接征象以及右心负荷增加的间接征象等,利用床旁超声心动图可以对患者是否患有急性肺栓塞的情况进行明确的判定,在临床上具有非常重要的意义。     

超声检查在老年急性肺栓塞诊断及疗效评估中的价值

目的探讨超声检查在老年急性肺栓塞诊断及疗效评估中的价值。方法选择老年急性肺栓塞患者27例,所有患者均于急性肺栓塞发病前、发病时以及治疗病情缓解后进行超声心动图、下肢深静脉超声检查,并行末梢血氧饱和度、血压、血浆D-二聚体等检测。结果与发病前比较,老年急性肺栓塞患者发病时收缩压、舒张压、末梢血氧饱和度明显下降,血浆D-二聚体明显升高,差异有统计学意义(P<0.05)。经治疗病情缓解后,患者的血压、末梢血氧饱和度均恢复或接近急性发病前的平时水平,血浆D-二聚体明显下降(P<0.05)。急性肺栓塞发病时,患者右心房、右心室增大,主肺动脉及下腔静脉增宽,三尖瓣反流速度增快,肺动脉收缩压明显增高,与发病前比较,差异有统计学意义(P<0.05)。经治疗病情缓解后,患者右心房、右心室、主肺动脉及下腔静脉均恢复或接近急性发病前的平时水平,三尖瓣反流速度及肺动脉收缩压明显下降。老年急性肺栓塞患者发病时下肢深静脉血栓超声检出率高达77.8%。结论超声心动图及下肢深静脉超声同时结合其他各类检查是老年急性肺栓塞诊断必不可少的辅助检查手段,为老年急性肺栓塞的早期诊断、治疗及疗效评估提供有力的帮助。     

超声心动图诊断急性肺动脉栓塞的价值

目的 :分析评价床旁超声心动图 (ECHO)在急性肺动脉栓塞 (APE)诊断中的实用价值。方法 :采用经胸ECHO对临床怀疑APE的 5 8例患者在 4～ 6h内行床旁ECHO检查。结果 :超声直接检出主肺动脉及左右肺动脉主干近端血栓者 4例 ,均被外科手术或肺动脉造影证实。本组具有典型右心负荷过重超声征象者 15例 (其中包括具有超声直接征象的 4例 ) ,核素肺灌注 通气扫描提示为双肺多发性大面积栓塞。仅右房、右室轻度增大或肺动脉轻度增宽者 19例 ,ECHO无改变者 2 4例 ,但核素肺灌注 通气扫描均提示为肺段或亚段栓塞。结论 :ECHO能够发现主肺动脉、左右肺动脉干内附壁血栓直接提示肺动脉栓塞 ,或根据右室负荷过重表现间接提示肺栓塞的可能 ,但对肺段或亚段栓塞者超声不能作出或排除诊断。     

41例闭塞性肺动脉高压患者应用多普勒超声心动图法与右心导管法测定肺动脉压力的比较

目的:评价多普勒超声心动图法估测肺动脉收缩压(PASP)的可靠性.方法:用右心导管法(RHC)与多普勒超声心动图法分别测定闭塞性肺动脉高压患者的PASP,并将其结果进行比较.结果:多普勒超声心动图法与右心导管法测量PASP值,两者间比较有显著性差异(P＜0.05),平均差为(11.85±5.02)mmHg(1 mmHg=0.133 kPa),但两种方法得到的数值具有一定的相关性(r=0.635,P＜0.05).PASP值与动脉二氧化碳分压、肺泡-动脉氧差、血氧饱和度有关.结论:多普勒超声心动图法测量PAPS值与右心导管法有相关性,多普勒超声心动图法可作为估测肺动脉压力的一种可靠的无创检查方法.     

超声心动图测量肺动脉压力校正方法的研究

目的:采用超声心动图测量肺动脉压力,研究其校正方法,并与右心漂浮导管法作比较,以探查经校正过的测量方法是否较为精确。方法:选取我院经右心漂浮导管检测肺动脉压力的患者30例,同一天行超声心动图检查,通过测算下腔静脉压评估右心房压以及测算肺动脉瓣过瓣压两个因素来校正超声心动图测量的肺动脉收缩压、肺动脉平均压与肺动脉舒张压,校正前及校正后分别与右心漂浮导管法的测量值相比较。结果:未校正超声心动图法与右心漂浮导管法比较,肺动脉收缩压、肺动脉舒张压、肺动脉平均压的差异均有统计学意义(P=0.028、0.013、0.044);校正后超声心动图法与右心漂浮导管法比较,肺动脉收缩压、肺动脉舒张压、肺动脉平均压差异均无统计学意义(P=0.181、0.351、0.505)。校正后超声心动图法测肺动脉收缩压、肺动脉舒张压、肺动脉平均压(r=0.95、0.91、0.96)比未校正时(r=0.88、0.89、0.94)更接近右心漂浮导管法测量值,相关性更高。结论:校正后超声心动图法测量肺动脉压力与右心漂浮导管法的测量值更接近,有更高的临床价值。     

慢性阻塞性肺病患者左心室心肌做功指数

目的 组织多普勒成像测量心肌做功指数(MPI)评价慢性阻塞性肺病(COPD)患者左心室功能.方法 入选46例稳定期COPD及22例年龄性别匹配的健康者,根据肺动脉收缩压将COPD患者分为肺动脉高压组,肺动脉压力正常组,均完成经胸超声心动图检查,并用组织多普勒成像技术测量左室MPI.结果 COPD肺动脉高压组的左室MPI明显高于COPD肺动脉压力正常组和正常对照组(P<0.01),COPD肺动脉压力正常组左室MPI轻度高于正常对照组(P<0.05),左室MPI与肺动脉收缩压呈正相关(r=0.59,P<0.01).结论 左室射血分数正常的COPD患者存在左心室收缩和舒张功能障碍,尤其是伴有肺动脉高压的患者,MPI是一种较好反映COPD患者左心室功能障碍的指标.     

超声心动图诊断肺动脉高压157例分析

目的探讨超声心动图诊断肺动脉高压(PH)的临床价值。方法对157例确诊为PH患者给予超声心动图及CT、X线、肺动脉造影等检查,部分给予右心导管测量肺动脉收缩压(PASP),并与超声心动图测量肺动脉压值进行对比分析。结果本组157例患者中,经超声心动图确诊患者148例,确诊率94.3%。结合其他检查全部确诊。超声心动图误诊的9例中,6例为右肺动脉狭窄,3例为左肺动脉狭窄。肺动脉高压患者超声心动图检查主要表现为右心室肥厚增大,右心房扩大,肺动脉增宽,收缩期三尖瓣可见反流,反流频谱呈高速。30例患者右心导管测量PASP与超声心动图测量比较,差异无统计学意义(P>0.05)。结论超声心动图诊断PH具有准确率高、方便快捷、无创性、可重复性高等特点,且对病因的明确具有重要意义。     

慢性阻塞性肺病患者心房颤动与心脏结构的关联性

目的 分析慢性阻塞性肺病（COPD）患者初发心房颤动与心脏结构的关联性。方法 将426例COPD患者分成窦性心律组（n=376）和初发房颤组（n=50）通过单因素分析得出COPD初发房颤的影响因素,再运用logistic回归分析COPD患者初发房颤的高危因素。结果 单因素分析显示与窦性心律组比较,初发房颤组患者在年龄、冠心病史、右心室内径（RVD）、左心房内径（LAD）、右心房内径（RAD）、肺动脉内径（PAD）方面差异具有统计学意义（P<0.05）,在初发房颤影响因素logistic回归分析中LAD（P<0.05）、RAD（P<0.05）是COPD患者初发房颤的危险因素。结论 COPD患者初发房颤与心脏结构有关联,左心房及右心房增大是COPD患者初发房颤的独立相关因素。     

肺血栓栓塞症患者高敏C反应蛋白水平与肺动脉压相关性的研究

目的探讨急、慢性肺血栓栓塞症患者血清高敏C反应蛋白（high-sensitive C-reactive protein,hs-CRP）的差异及其与肺动脉压之间的相关性。方法选择肺血栓栓塞症患者102例,其中急性44例,慢性58例。所有患者均经多普勒超声心动图检查,将两组患者各自分为肺动脉压正常组与高压组,采用颗粒增强免疫透射比浊法检测hs-CRP水平。结果急性组hs-CRP（24.0±13.4 mg/L）明显高于慢性组（5.2±4.6 mg/L）（P〈0.01）。急性患者中肺动脉压正常组与高压组hs-CRP无明显差异（P=0.338）。慢性患者肺动脉压正常组hs-CRP（3.3±3.0）明显低于高压组（9.5±4.7 mg/L）（P〈0.05）。慢性肺血栓栓塞症肺动脉高压组患者hs-CRP水平和肺动脉压呈正相关（P〈0.05）。结论急性肺血栓栓塞症患者血清hs-CRP水平明显升高,慢性肺血栓栓塞症肺动脉高压组患者血清hs-CRP水平和肺动脉压显著相关。血清hs-CRP水平可用于PTE的危险分层及判断预后。     

M-mode echocardiography in acute pulmonary embolism

Twenty-two patients with acute pulmonary embolism were examined by M-mode echocardiography. It was possible to examine both ventricles (with precordial approach) and the right branch of the pulmonary artery (with suprasternal approach) in all patients. With significant pulmonary embolism there occurs dilatation of the right ventricle and of the right branch of the pulmonary artery. The size of the right branch of the pulmonary artery in patients was significantly different from that of healthy volunteers. However, no significant correlation between the degree of anatomic changes (documented by echocardiography) and haemodynamics in the lesser circulation was found. Literature concerning other possibilities of echocardiography in the diagnosis of acute pulmonary embolism is reviewed. Echocardiography represents a suitable complement to diagnostic methods used for the assessment of acute states.     

心电图及心脏超声在急性肺栓塞诊断及危险分层中的意义

目的分析心电图及心脏超声在急性肺栓塞(APE)诊断及危险分层中的意义。 方法选择2018年1月至2021年1月对我院经肺动脉造影(CTA)确诊的肺栓塞患者120例,其中低危34例,中危70例,高危16例,根据危险分层及临床治疗需要分为中高风险组86例,低风险组34例。分析两组心电图及心脏超声。 结果中高风险组与低风险组性别比例、年龄等基线资料无统计学差异(P>0.05)。心电图显示：中高风险与低风险组间比较,心电图异常的发生率分别为窦性心动过速31例(36.05%)、3例(8.82%),房性心律失常13例(15.12%),肺性P波1例(1.16%),电轴右偏9例(10.47%)、3例(8.82%),右束支阻滞11例(12.79%)、3例(8.82%),S_ⅠQ_ⅢT_Ⅲ 24例(27.91%),肢体导联低电压7例(8.14%),胸前导联T波倒置15例(17.44%)。中高风险组窦性心动过速及房性心律失常的发生率较低风险组显著升高(P<0.05);心脏超声：中高风险与低风险组间比较,右房内径(38.34±6.52、32.44±4.31)mm,右室内径(21.66±4.35、18.76±1.48)mm,左房内径(33.36±4.46、32.71±4.78)mm,左室内径(43.53±4.88、46.24±4.04)mm,射血分数(61.37±7.25%、62.32±5.28%),三尖瓣返流75例(87.21%)、24例(70.59%),肺动脉收缩压增高28例(32.56%)、4例(11.76%),中高风险组在右房内径、右室内径、三尖瓣返流及肺动脉高压的发生率较低风险组显著升高(P<0.05)。 结论APE心电图及心脏超声有特征性改变,两者在APE的诊断及危险分层中具有临床意义。     

Chest radiographs in acute pulmonary embolism. Results from the International Cooperative Pulmonary Embolism Registry

OBJECTIVES: To characterize chest radiographic interpretations in a large population of patients who have received a diagnosis of acute pulmonary embolism and to estimate the sensitivity and specificity of chest radiographic abnormalities for right ventricular hypokinesis that has been diagnosed by echocardiography. DESIGN: A prospective observational study at 52 hospitals in seven countries. PATIENTS: A total of 2,454 consecutive patients who had received a diagnosis of acute pulmonary embolism between January 1995 and November 1996. RESULTS: Chest radiographs were available for 2,322 patients (95%). The most common chest radiographic interpretations were cardiac enlargement (27%), normal (24%), pleural effusion (23%), elevated hemidiaphragm (20%), pulmonary artery enlargement (19%), atelectasis (18%), and parenchymal pulmonary infiltrates (17%). The results of chest radiographs were abnormal for 509 of 655 patients (78%) who had undergone a major surgical procedure within 2 months of the diagnosis of pulmonary embolism: normal results for chest radiograph often accompanied pulmonary embolism after genitourinary procedures (37%), orthopedic surgery (29%), or gynecologic surgery (28%), whereas they rarely accompanied pulmonary emboli associated with thoracic procedures (4%). Chest radiographs were interpreted to show cardiac enlargement for 149 of 309 patients with right ventricular hypokinesis that was detected by echocardiography (sensitivity, 0.48) and for 178 of 485 patients without right ventricular hypokinesis (specificity, 0.63). Chest radiographs were interpreted to show pulmonary artery enlargement for 118 of 309 patients with right ventricular hypokinesis (sensitivity, 0.38) and for 117 of 483 patients without right ventricular hypokinesis (specificity, 0.76). CONCLUSIONS: Cardiomegaly is the most common chest radiographic abnormality associated with acute pulmonary embolism. Neither pulmonary artery enlargement nor cardiomegaly appears sensitive or specific for the echocardiographic finding of right ventricular hypokinesis, an important predictor of mortality associated with acute pulmonary embolism.     

Should Transesophageal Echocardiography Become a Routine Test in Patients with Suspected Pulmonary Thromboembolism?

Pulmonary thromboembolism presents in two clinical subsets: acute pulmonary embolism (PE) with or without right heart thrombi or paradoxical embolism and chronic thromboembolic pulmonary hypertension (CTEPH). Both PE and CTEPH have been underdiagnosed and carry high mortality rates. Acute massive PE is a hemodynamic entity leading to right ventricular overload readily identified with the use of transthoracic echocardiography. Transesophageal echocardiography (TEE) is a noninvasive bedside technique that has high diagnostic accuracy for the detection of central pulmonary thromboembolism. Due to the high prevalence of central pulmonary thromboembolism in acute PE, TEE is a useful method to provide the necessary proof for the institution of thrombolytic therapy. In the subset of patients with acute PE combined with right heart thrombi or paradoxical embolism, TEE is the technique of choice to guide surgery. CTEPH presents as primary pulmonary hypertension, but it has become a surgically curable disease. TEE is a fast, fairly sensitive, and highly specific diagnostic bedside modality to select surgical candidates with CTEPH. TEE should become a routine test in patients with suspected massive acute PE, suspected right heart thrombi, or paradoxical embolism associated with acute pulmonary embolism and in patients with primary pulmonary hypertension to select those having CTEPH who are suitable for surgery.     

Diagnostic value of transoesophageal echocardiography in suspected haemodynamically significant pulmonary embolism

OBJECTIVE—To assess the value of transoesophageal echocardiography (TOE) for diagnosing suspected haemodynamically significant pulmonary embolism and signs of right ventricular overload at standard echocardiography.
METHODS—113 consecutive patients (58 male; 55 female), mean (SD) age 53.6 (13.3) years, in whom there was clinical suspicion of pulmonary embolism and right ventricular overload on transthoracic echocardiography, underwent TOE in addition to routine diagnostic procedures to identify pulmonary artery thrombi.
RESULTS—TOE revealed thrombi in 32 of 51 patients who had suspected acute pulmonary embolism and in 31 of 62 with suspected chronic pulmonary embolism. In one patient a pulmonary angiosarcoma rather than chronic pulmonary embolism was found at surgery. The diagnosis of pulmonary embolism was confirmed in 77 patients by scintigraphy, spiral computed tomography, angiography, or necropsy (reference methods). While TOE failed to provide a diagnosis of pulmonary embolism in 15 of these 77 patients, no false positive findings were reported (sensitivity 80.5%, specificity 97.2%). In 11 and 26 cases, respectively, the thrombi were confined to the left or right pulmonary artery. Bilateral thrombi were found in 25 patients. Mobile thrombi were observed only in acute pulmonary embolism (in 19 of 32 patients). No complications of TOE were noted.
CONCLUSIONS—TOE permits visualisation of pulmonary arterial thrombi, confirming the diagnosis in the majority of patients with pulmonary embolism and right ventricular overload. This may be useful for prompt decision making in patients with haemodynamic compromise considered for thrombolysis or embolectomy.


Keywords: pulmonary embolism; transoesophageal echocardiography     

Silent Pulmonary Embolism of a Large Right Atrial Thrombus

We report the case of a patient who was admitted to the hospital with acute pulmonary embolism 2 weeks after a complicated pelvis fracture. Echocardiography revealed a large, long, and mobile thrombus in the right atrium. The patient was scheduled to undergo urgent surgical thrombectomy. Preoperative echocardiography did not detect any thrombi in the right heart and pulmonary artery. The obvious embolism of this large thrombus in the pulmonary circulation was silent as the patient remained asymptomatic and hemodynamically stable. We discuss the contribution of echocardiography to the appropriate therapeutic management of right atrial thrombi and particularly to the cancellation of urgent operative thrombectomy.