摘要
目的 探讨超声多普勒心动图 (UCG)在判断静脉内溶栓治疗急性肺栓塞 (APE)疗效中的价值。方法 对 12例APE患者静脉内给予重组组织型纤溶酶原激活剂 (rt PA) 10 0mg溶栓治疗 ,溶栓前、后行同位素肺通气 /灌注扫描和UCG检查 ,观察UCG指标的变化 ,并与同位素肺通气 /灌注扫描结果对照。结果 本组 12例APE患者 ,溶栓前 2 40个肺段中灌注缺损 12 6段 (5 2 .5 % ) ,每例平均(10 .5± 2 .9)个肺段。UCG也均显示右心房、室扩大伴有右室壁运动降低 ,左心房、室缩小并有室间隔向左侧偏移 ,三尖瓣中至大量返流伴肺动脉高压 [(85 .4± 2 3.2 )mmHg (1mmHg =0 .133kPa) ]和主肺动脉增宽等APE的特征性改变。溶栓后 (2 9.2± 4.0 )h同位素扫描有 6 0个栓塞肺段再灌注 (47.6 % ) ,平均 (5 .0± 2 .2 )段 ;同时 [溶后 (2 8.5± 4.7)h]UCG也显示右心房、室均显著缩小 [(- 2 .7± 1.8)mm和(- 3.6± 2 .6 )mm ,P均 <0 .0 5 ]并有右室壁运动的改善 ,左心房、室均显著增加 [(+1.8± 1.2 )mm和(+4 .8± 3.7)mm ,P均 <0 .0 5 ]伴室间隔移位改善 ,肺动脉收缩压显著降低 [(- 15 .2± 5 .4)mmHg,P<0 .0 5 ]伴有三尖瓣返流量的减少及主肺动脉显著回缩 [(- 1.5± 1.4)mm ,P均 <0 .0 5 ]等APE再灌注的特征性改变。这些改变在溶栓后 (
Objective To assess the value of Doppler echocardiography in judgment of the efficacy of intravenous thrombolysis for acute pulmonary embolism (APE).Methods Both of the lung ventilation/perfusion scan and bedside Doppler echocardiography were performed before and after intravenous thrombolysis with 100mg recombinant tissue type plasminogen activator(rt PA) in 12 patients with APE, and the results of echocardiographic changes were observed, and compared with those of the lung perfusion scan. Results In 12 cases of APE, the perfusion defect in the lung scan were detected in 126 of 240 lung segments (52.5%) before thrombolysis with average defect segments of 10.5±2.9. Meanwhile, Doppler echocardiography also showed the characteristic changes of APE, including dilatation of right atrium and ventricle with right ventricular dysfunction, dimensional reductions of left atrium and ventricle with interventricular septum leftward bulging during diastole and, moderately or severely tricuspid valve regurgitation with pulmonary hypertension [(85.4±23.2) mm Hg on average] and widened main pulmonary artery. Thrombolysis was all successful in 12 patients. The reperfusion in lung scan were detected in 60 of 126 defect lung segments (47.6%) at (29.2±4.0) hours after thrombolysis, with average reperfusion segments of 5.0±2.2; and Doppler echocardiography conducted at (28.5±4.7) hours after thrombolysis also showed the characteristic changes of APE reperfusion, including right atrium and ventricle diameter decreased [(-2.7±1.8) mm and (-3.6±2.6) mm, respectively, both P <0.05] with right ventricular dysfunction improved, left atrium and ventricle diameter increased [(+1.8±1.2)] mm and (+4.8±3.7) mm, respectively, both P <0.05] with interventricular septum leftward bulging improved, pulmonary artery systolic pressure decreased [(-15.2±5.4) mmHg, P <0.05] with tricuspid regurgitation attenuated and main pulmonary artery diameter reduced [(-1.5±1.4) mm, P <0.05]. More importantly, the echocardiographic changes above had occurred early (8.2±1.5) hours after thrombolysis. Conclusion It was indicated that the results of bedside Doppler echocardiography were agreement with those of lung ventilation/perfusion scan in evaluting the efficacy of thrombolytic therapy for APE, and had important clinical value, which merits further investigation.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2001年第5期271-273,共3页
Chinese Journal of Cardiology
