心超在评估急性肺栓塞患者预后中的价值

发布时间：2018-03-17 07:45

本文选题：心脏超声　切入点：肺栓塞　出处：《复旦学报(医学版)》2015年03期 　论文类型：期刊论文

【摘要】：目的观察急性肺栓塞(pulmonary embolism,PE)患者的心超表现,评估其在判断PE预后方面的价值及其影响因素。方法分析2008年1月至2012年12月复旦大学附属中山医院收治的697例经肺动脉造影或通气血流灌注检查的急性PE患者,其中有331病例进行了心超检查,根据检查结果分为2组,即右心功能正常或轻度受损组(normal and mildly impaired right heart function,No RVD组)和急性右心功能不全组(acute right ventricular dysfunction,RVD组)。随访患者6个月的预后情况,并进行相关分析。结果 331例急性PE患者中发生右心功能不全的病例为95例(28.7%),未发生右心功能不全的病例为236例(71.3%)。通过两组患者6个月的随访,发现RVD组不良事件发生率明显高于No RVD组。多因素Logistic回归分析发现心超表现中肺动脉高压(P=0.003,OR=4.13,95%CI:3.00~5.67),肺动脉增宽(P=0.005,OR=4.72,95%CI:2.70~8.26)和右室扩大(P=0.007,OR=163.92,95%CI:65.09~412.79)是评估PE预后不良事件发生的预测因子。结论心超随访有助于急性PE患者的预后评价,肺动脉高压、肺动脉增宽、右室扩大可能是判断急性PE合并右心功能不全患者不良预后的心超表现。
[Abstract]:Objective to observe the cardiac ultrasound findings in patients with acute pulmonary embolism (Pe), pulmonary embolism (PE) and pulmonary embolism (PE). Methods from January 2008 to December 2012 in Zhongshan Hospital of Fudan University, 697 patients with acute PE underwent pulmonary angiography or ventilation perfusion examination were analyzed. Three hundred and thirty-one patients were examined by echocardiography and divided into two groups according to the results: normal and mildly impaired right heart function No RVD group (normal and mildly impaired right heart function No RVD group) and acute right ventricular dysfunction RVD group (acute right ventricular dysfunction RVD group). The prognosis of the patients were followed up for 6 months. Results among 331 patients with acute PE, 95 had right ventricular insufficiency and 236 had no right ventricular dysfunction. It was found that the incidence of adverse events in RVD group was significantly higher than that in No RVD group. Multivariate Logistic regression analysis showed that pulmonary hypertension in cardiac hypertrophy (P0.003) 4.1395 CI: 3.005.67, pulmonary artery widening (P0.005) 4.7295CI2.70: 8.26) and right ventricular enlargement (P0.007) were predictors of adverse events in PE. Conclusion Follow-up of cardiac hypertrophy is helpful to evaluate the prognosis of patients with acute PE. Pulmonary hypertension, pulmonary artery enlargement and right ventricular dilatation may be the poor prognosis of patients with acute PE with right ventricular insufficiency.
【作者单位】：复旦大学附属中山医院急诊科;复旦大学附属中山医院老年病科;复旦大学附属中山医院放射科;
【分类号】：R563.5

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