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目的探讨经胸超声心动图(TTE)在评价血压正常急性肺栓塞(APE)患者预后中的应用价值。方法就诊时血压正常的APE患者53例,TTE检出右心室扩张、肺动脉高压等间接征象作为急性右心功能不全的诊断标准,将患者分为急性右心功能不全组25例和右心功能正常组28例,对两组临床情况进行回顾分析。结果 TTE发现右心房、右心室或肺动脉内血栓7例。急性右心功能不全组与右心功能正常组在年龄、性别和高危因素方面差异无统计学意义(均为P>0.05)。在呼吸困难、就诊时心率、颈静脉怒张、P2亢进、血气分析指标(PCO_2除外)和TTE检查指标方面,两组比较差异均有统计学意义(均为P<0.05)。右心功能不全组与正常组住院14d的肺栓塞相关病死率为20%比0%,预后不良发生率为28%比0%,差异均有统计学意义(均为P<0.05)。右心功能不全组经抗凝治疗后,20例复查血气分析和TTE,与治疗前比较差异均有统计学意义(均为P<0.05)。TTE检查示右心功能不全可作为肺栓塞相关死亡的预测指标,其敏感度为100%,特异度为58%,阳性预测值20%,阴性预测值100%。结论 TTE可无创评估右心功能状况。右心功能不全是APE高病死率和不良预后的识别指标,TTE可识别出具有早期死亡风险的人群。右心功能正常患者短期预后较好。
Objective To investigate the value of transthoracic echocardiography (TTE) in evaluating the prognosis of patients with normotensive acute pulmonary embolism (APE). Methods Totally 53 cases of normotensive patients with APE at the time of diagnosis were diagnosed as indirect diagnostic criteria of right ventricular dysfunction by right ventricular dilatation and pulmonary hypertension by TTE. Twenty-five patients with acute right ventricular dysfunction and normal right ventricular function Group 28 cases, the clinical situation of the two groups were analyzed retrospectively. Results TTE found thrombus in the right atrium, right ventricle or pulmonary artery in 7 cases. There was no significant difference in age, sex and risk factors between acute right ventricular dysfunction group and normal right ventricular function group (all P> 0.05). There were significant differences between the two groups in terms of dyspnea, heart rate, jugular vein engorgement, hyperparathyroidism, blood gas analysis index (except PCO 2) and TTE examination indicators (all P <0.05). The mortality rate of pulmonary embolism in right-ventricular dysfunction group was 14% in 20% and 0% in hospitalized patients, and 28% and 0% in poor prognosis group (all P <0.05). Right anticoagulant group after anticoagulant therapy, 20 cases of blood gas analysis and TTE review, compared with before treatment were statistically significant (both P <0.05). TTE showed that right ventricular dysfunction can be used as a predictor of pulmonary embolism-related death, with a sensitivity of 100%, a specificity of 58%, a positive predictive value of 20% and a negative predictive value of 100%. Conclusion TTE can be noninvasive assessment of right cardiac function. Right ventricular dysfunction is a marker of high APE mortality and poor prognosis, and TTE identifies a population at risk of early death. Right-heart patients with normal short-term prognosis is good.