急性肺动脉血栓栓塞的DSCT诊断及疗效评估

发布时间：2018-05-02 15:00

  本文选题：急性肺栓塞 + 介入治疗　； 参考：《昆明医科大学》2013年硕士论文

【摘要】：目的：通过回顾分析急性肺动脉血栓栓塞的DSCT表现及不同方法治疗后的影像学改变,探讨DSCT对急性肺动脉血栓栓塞的诊断及治疗后随访的价值,同时对照分析各种治疗方法的有效率,加强对急性肺动脉血栓栓塞诊断及治疗的认识,提高早期诊断率及治疗疗效,减少漏诊、误诊和死亡率。材料和方法：回顾性分析本院收治的47例急性肺动脉血栓栓塞病例。全部患者治疗前均作了DSCTPA检查,并在治疗后7天至2个月内作过2次以上复查；其中20例行溶栓治疗,18例行单纯抗凝治疗,9例进行了介入治疗。一、分析DSCT表现：(1)肺动脉栓塞部位及栓子形态；(2)栓塞动脉管径测量；(3)不同后处理技术对各级肺动脉病灶的检出率。二、依据临床症状改善及影像学变化,综合分析不同治疗方案的疗效对比：疗效评价划分为无效(包括无变化、恶化和死亡)、有效和显效。(1)无效：临床症状无明显缓解,治疗后复查CT提示栓子无变化。恶化(含死亡)：临床症状较前加重,治疗后复查CT提示栓子较前增大、增多。(2)有效：临床症状明显减轻,治疗后复查CT提示栓子减少、缩小≥1/2；(3)显效：临床症状减轻,治疗后复查CT提示栓子缩小、减小≥1/4。数据采用excel录入数据,利用SPSS17.0统计软件包进行相关数据分析,行卡方检验,秩和检验。 结果：一、影像学表现：(1)右肺动脉累及281处,左肺动脉累及101处,双肺下叶动脉累及256处,双肺中上叶动脉累及94处,右肺动脉栓塞较左肺动脉常见,双下叶肺动脉栓塞较中上肺常见；栓子形态呈马鞍征、漂浮征、环征、轨道征表现为血栓游离于肺动脉管腔内,提示新鲜血栓(34/47,75.56%)。(2)多数栓塞动脉血管管径增宽(293/385,76.10%),血管管径无变化23.90%；(3)在1级肺动脉血管肺栓塞检出率MPR、MIP、VR三种处理方式无任何差别；在2—3级肺动脉血管MPR检出率高于MIP和VR,但结果不具有统计学意义(P=0.13)；在4—5级肺动脉血管MPR检出率较高,与MIP和VR差异显著(P0.001)；二、疗效对比：溶栓组、单纯抗凝组显效率高于介入组,差异有显著性(P0.001)；介入组有效率高于溶栓组及抗凝组,差异具有显著性(P0.001)；总有效率介入组、单纯抗凝组、溶栓组三组间比较无差异。 结论：一、影像学表现 1.急性肺动脉血栓栓塞右肺发病率高于左肺,双下肺高于双上肺；栓子形态呈马鞍征、漂浮征、环征、轨道征提示为新鲜血栓。 2.多数急性栓塞血管管径增宽。 3.在1级肺动脉血管栓塞检出率MPR、MIP、VR三种后处理方式无任何差别；在2—3级肺动脉血管MPR检出率高于MIP和VR；在4—5级肺动脉血管MPR检出率显著高于MIP和VR。 二、疗效评估 单纯抗凝、溶栓及介入治疗均是急性PTE治疗的有效方法,急性大面积肺栓塞介入治疗的有效率高于前两者,但具有一定的风险性。 三、DSCT是诊断急性肺动脉血栓栓塞和治疗后随访的首选影像学检查方法。
[Abstract]:Objective: to investigate the value of DSCT in the diagnosis and follow-up of acute pulmonary thromboembolism (APE) by retrospectively analyzing the DSCT manifestations of acute pulmonary thromboembolism (APE) and the imaging changes after different treatments. At the same time, the effective rate of various treatment methods was compared and analyzed to strengthen the understanding of diagnosis and treatment of acute pulmonary thromboembolism, to improve the early diagnosis rate and therapeutic effect, to reduce missed diagnosis, misdiagnosis and mortality. Materials and methods: 47 cases of acute pulmonary thromboembolism were retrospectively analyzed. All the patients were examined by DSCTPA before treatment, and 2 or more reexaminations were made within 7 days to 2 months after treatment, of which 20 cases were treated with thrombolytic therapy and 18 cases were treated with anticoagulant therapy alone, 9 cases were treated with interventional therapy. The main results of this study were as follows: (1) DSCT findings: (1) the location of pulmonary embolism and the shape of embolism (2) the diameter of embolism artery were measured. (3) the detectable rate of pulmonary artery lesions at all levels was detected by different post-processing techniques. Secondly, according to the improvement of clinical symptoms and imaging changes, comprehensive analysis of the efficacy comparison of different treatment plans: the evaluation of efficacy was divided into invalid (including no change, deterioration and death, effective and effective. 1) no significant relief of clinical symptoms. Ct examination showed no change in embolus after treatment. Deterioration (including death: clinical symptoms were more severe, CT examination after treatment showed that embolus was larger than before, increase. 2) effective: clinical symptoms were obviously alleviated, after treatment CT showed that embolus decreased, narrowing 鈮，

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