摘要
目的:分析血流动力学稳定伴右心室功能不全(right ventricular dysfunction,RVD)的急性肺血栓栓塞症(简称急性肺栓塞,acute pulmonary embolism,APE)的临床特点、诊断、治疗和预后,以提高对血流动力学稳定伴右心室功能不全的急性肺栓塞的认识。方法:对我院近8年来141例急性肺栓塞患者进行回顾分析,根据超声心动图是否存在右心室功能不全将血流动力学稳定的131例患者分为两组,分别为血流动力学稳定伴RVD(伴RVD组)50例和血流动力学稳定不伴RVD(不伴RVD组)81例,对两组患者的高危因素、临床特点、诊断及治疗等进行分析及比较。结果:血流动力学稳定伴RVD的急性肺栓塞占所有的急性肺栓塞的比率为35.5%。伴RVD组的高危因素主要包括慢性静脉机能不全、陈旧深静脉血栓形成、骨折及手术等。临床表现伴RVD组以呼吸困难最常见(68.0%),与不伴RVD组比较仅晕厥、P2亢进、呼吸频率>20次/分、心率>100次/分、低碳酸血症、心电图异常更常见,差异均有统计学意义(P<0.05)。急性肺栓塞患者同时存在晕厥、P2亢进和心电图异常时,对右心室功能不全的阳性预测率可达100%。静脉溶栓治疗伴RVD组(42.0%)明显多于不伴RVD组(9.9%),差异有统计学意义(P<0.01)。结论:血流动力学稳定伴RVD的急性肺栓塞是肺栓塞的重要亚组,对临床上存在晕厥、P2亢进、心电图异常的肺栓塞患者,应尽早行超声心动图检查明确有无RVD,以指导进一步治疗。
Objective：To improve cognition of acute pulmonary embolism（APE） subgroup through analyzing the patients＇ clinical char- acteristics, diagnosis, therapy and prognosis of hemodynamically stable APE with right ventricular dysfunction（RVD）.
Methods ：A total of 141 APE patients with echocardiogram confirmed RVD treated in our hospital in recent 8 years were analyzed retrospectively. 10 patients with hemodynamically unstable APE were excluded. 131 patients with hemodynamically stable APE were classified into two groups, RVD group（ n = 50）and non-RVD group（ n = 81 ）. The risk factors, clinical features, diagnosis and therapy were analyzed and compared in both groups.
Resuhs：（1）Hemodynamically stable APE with RVD was 35.5% of all APE patients. （2）The risk factors of RVD included the chronic venous insufficiency, deep venous thrombosis, bone fracture and surgery, etc. （3）In RVD group,68% of patients had dyspnea,it was the most common clinical characters of RVD. The other clinical manifestations including syncope （34%） , accentuated P2（ 66% ）, accelerated respiration（ 66% ） ,tachycardia（ 44% ）, decreased arterial CO2 partial pressure（ 75% ）, abnormal electrocardiogram（74% ）were significantly different from non-RVD group（ P 〈 0. 05 ）. （4）The positive predictive value for RVD was 100% if syncope, loud P2 and electrocardiogram abnormality existed simultaneously in APE patients. （5）The patients received venous thrombolysis in RVD group was 42% ,in non-RVD group was 9. 9% （P 〈0. 01 ）
Conclusion ： The hemodynamically stable APE with RVD was an important subgroup of APE. Echocardiogram should be performed as early as possible to confirm RVD diagnosis for appropriate treatment if APE patients presented with syncope, accentuated P2 and abnormal electrocardiogram.
出处
《中国循环杂志》
CSCD
北大核心
2008年第6期441-444,共4页
Chinese Circulation Journal
关键词
肺栓塞
右心室功能不全
超声心动图
Pulmonary embolism
Right ventricular dysfunction
Echocardiography
