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目的探讨超声心动图对下肢深静脉血栓(DVT)患者无症状和轻微症状肺栓塞(PE)的筛查价值。方法选择自2014年1月—2016年1月在该院入住的89例DVT患者为研究对象。入院后均进行CTPA检查,并根据检查结果分组:发生PE组(观察组)59例和未发生PE组(对照组)30例,观察组又分为症状典型的PE组33例以及无症状和轻微症状(症状不典型)PE组26例。(1)回顾性分析三组患者一般临床资料。(2)对患者空腹血浆D-二聚体阳性率进行分析。(3)比较三组患者经胸超声心动图检查结果。结果 (1)观察组与对照组比较外科手术史[54.2%(32/59)与16.7%(5/30)]、既往有无梗死史[3.4%(2/59)与10.0%(3/30)]、是否合并有心脏疾病[5.1%(3/59)与20.0%(6/30)]差异均有统计学意义(χ~2值分别为11.56、13.67、6.63,P均<0.05)。(2)89例DVT患者中有83例D-二聚体升高,观察组D-二聚体阳性率为94.9%(56/59),对照组为90.0%(27/30),二组间D-二聚体阳性率比较差异无统计学意义(χ~2=0.76,P=0.382)。(3)超声心动图结果显示观察组中33例症状典型PE患者右心室前壁厚度[(5.51±1.05)mm]、右心室流出道内径[(28.33±2.55)mm]、右心室舒张期横径[(42.35±2.13)mm]、主肺动脉内径[(30.37±3.01)mm]、肺动脉压[(48.57±2.37)mmHg]明显高于症状不典型PE组[(3.05±1.16)mm、(26.35±2.16)mm、(36.76±3.25)mm、(26.22±2.56)mm、(31.53±5.26)mmHg]和对照组[(2.93±1.03)mm、(17.21±1.53)mm、(34.24±3.13)mm、(17.80±1.01)mm、(24.53±2.37)mmHg],差异均有统计学意义(P均<0.01),而26例症状不典型PE组患者右心室流出道内径、主肺动脉内径、肺动脉压高于对照组,差异均有统计学意义(P均<0.01)。结论通过患者临床资料以及血生化检查结果,发现患者外科手术史、既往有梗死史、合并有心脏疾患与PE发生密切相关,而经胸超声心动图能早期检测出三尖瓣反流速度增快,肺动脉高压的征象,为临床早期发现无症状和轻微症状PE、评估患者病情及临床治疗提供依据,可作为对存在PE危险因素的人群的一种筛查手段。
Objective To investigate the value of echocardiography in the screening of asymptomatic and minor symptoms of pulmonary embolism (PE) in patients with lower extremity deep venous thrombosis (DVT). METHODS: A total of 89 DVT patients admitted to the hospital from January 2014 to January 2016 were enrolled in this study. All patients underwent CTPA examination after admission and were grouped according to the examination results. There were 59 cases in PE group (observation group) and 30 cases in PE group (Control group). The observation group was further divided into 33 cases of typical PE group and asymptomatic Mild symptoms (atypical symptoms) PE group of 26 cases. (1) The clinical data of three groups were retrospectively analyzed. (2) To analyze the positive rate of fasting plasma D-dimer in patients. (3) Compare the transthoracic echocardiography of the three groups. Results Compared with the control group, the observation group had a history of surgery (54.2% (32/59) vs 16.7% (5/30)), history of non-infarction history [3.4% (2/59) vs 10.0% (P <0.05). The difference was statistically significant (χ ~ 2 = 11.56, 13.67, 6.63, P <0.05 respectively) with or without heart disease (5.1% (3/59) vs 20.0% . (2) There were 83 cases of D-dimer in 89 patients with DVT, the positive rate of D-dimer in the observation group was 94.9% (56/59), the control group was 90.0% (27/30) There was no significant difference in the positive rate of D-dimer (χ ~ 2 = 0.76, P = 0.382). (3) The results of echocardiography showed that in the observation group, the anterior wall thickness of the right ventricle was (5.51 ± 1.05) mm in the 33 patients with typical PE symptoms, the diameter of the right ventricular outflow tract was (28.33 ± 2.55) mm, The diameter of the main pulmonary artery [(30.37 ± 3.01) mm] and pulmonary artery pressure (48.57 ± 2.37 mmHg) were significantly higher than those of the atypical PE group [(3.05 ± 1.16) mm, (26.35 ± 2.13) mm] (2.23 ± 1.03) mm, (17.21 ± 1.53) mm, (34.24 ± 3.13) mm, (36.76 ± 3.25) mm, (26.22 ± 2.56) mm and (31.53 ± 5.26) mmHg , (17.80 ± 1.01) mm, (24.53 ± 2.37) mmHg], respectively (all P <0.01), while the diameter of the right ventricular outflow tract, the diameter of the main pulmonary artery, the pulmonary artery pressure Higher than the control group, the difference was statistically significant (P all <0.01). Conclusion According to the clinical data of patients and the result of blood biochemical examination, the history of surgery, previous history of infarction, and heart disease complicated with PE were found. However, transthoracic echocardiography could early detect the rate of tricuspid regurgitation , Signs of pulmonary hypertension for early detection of asymptomatic and mild symptoms of PE, to assess the patient’s condition and clinical treatment provide a basis for the presence of PE risk factors in the population of a screening tool.