摘要
背景肺动脉栓子主要来源于下肢深静脉血栓,而栓子阻塞肺动脉及其分支可导致肺血管阻力增加及右心功能改变,但目前下肢深静脉栓塞及右心功能改变对急性肺栓塞(APE)患者的影响尚未完全明确。目的探讨APE患者下肢深静脉栓塞情况和右心功能改变及其临床意义。方法选取2016—2018年皖北煤电集团总医院收治的疑似APE患者80例,根据CT肺动脉造影(CTPA)检查结果分为APE组32例和非APE组48例,并根据APE危险分层标准将32例APE患者分为低危组8例、中危组18例和高危组6例。比较APE组与非APE组患者临床症状及体征、基础疾病、实验室检查指标、下肢深静脉栓塞情况、右心功能指标,并比较低危组、中危组、高危组患者下肢深静脉栓塞情况、右心功能指标。结果 (1)APE组与非APE组患者咯血、胸痛、胸闷、心悸、意识障碍、咳嗽、发热、低血压、慢性阻塞性肺疾病(COPD)、高血压、冠心病、心房颤动、肿瘤发生率比较,差异无统计学意义(P>0.05);APE组患者晕厥、单侧下肢肿胀、血脂异常发生率,有近期手术史或骨折者所占比例,红细胞计数及尿酸、纤维蛋白原、D-二聚体水平高于非APE组(P<0.05)。(2)APE组患者栓塞血管数目多于非APE组,栓子直径、右心室舒张末期内径(RVEDD)/左心室舒张末期内径(LVEDD)大于非APE组,双侧深静脉栓塞、深静脉栓塞、近端深静脉栓塞发生率高于非APE组,右心室壁运动幅度(RVWM)、右房室瓣环收缩期位移(TAPSE)小于非APE组,右房室瓣反流速度(TRV)快于非APE组(P<0.05)。(3)高危组患者栓塞血管数目多于低危组、中危组,栓子直径、RVEDD/LVEDD大于低危组、中危组,双侧深静脉栓塞、近端深静脉栓塞发生率高于低危组、中危组,RVWM、TAPSE小于低危组、中危组,TRV快于低危组、中危组(P<0.05);中危组患者栓塞血管数目多于低危组,栓子直径、RVEDD/LVEDD大于低危组,双侧深静脉栓塞、近端深静脉栓塞发生率高于低危组,RVWM、TAPSE小于低危组,TRV快于低危组(P<0.05)。低危组、中危组、高危组患者深静脉栓塞发生率比较,差异无统计学意义(P>0.05)。结论 APE患者多存在下肢深静脉栓塞及右心功能改变,且APE危险分层越高,下肢深静脉栓塞越严重、右心功能改变越大,因此针对出现下肢深静脉栓塞及右心功能改变的疑似APE患者需及时行CTPA检查以明确诊断并进行危险分层,以提高APE的防治效果。
Backgroud Pulmonary artery embolus mainly derive from lower extremity deep venous thrombosis,while embolus blocking in pulmonary artery and its branches may lead to increase of pulmonary vascular resistance and change of right ventricular function,but the impact of venous embolism of lower extremity and change of right ventricular function on patients with acute pulmonary embolism(APE)is not very clear yet. Objective To investigate the deep venous embolism of lower extremity and change of right ventricular function in patients with APE and its clinical significance. Methods A total of 80 patients with suspected APE were selected in General Hospital of Wanbei Coal and Power Group from 2016 to 2018,and they were divided into APE group(n=32)and non-APE group(n=48)according to the CTPA examination results,and then the 32 patients with APE were divided into A group(with low-risk APE,n=8),B group(with medium-risk APE,n=18)and C group(with high-risk APE,n=6)according to APE risk stratification criteria. Clinical symptoms and signs,basic diseases,laboratory examination results,deep venous embolism of lower extremity and index of right ventricular function were compared between APE group and non-APE group,meanwhile deep venous embolism of lower extremity and index of right ventricular function were compared in groups A,B and C. Results (1)No statistically significant difference of incidence of hemoptysis,chest pain,chest distress,palpitation,consciousness disorder,cough,fever,hypotension,COPD,hypertension,coronary heart disease,atrial fibrillation or tumour was found between APE group and non-APE group(P>0.05);incidence of syncope,unilateral lower limb swelling and dyslipidemia,proportion of patients with recent surgical history or fracture,RBC,UA,FIB and D-dimer in APE group were statistically significantly higher than those in non-APE group(P<0.05).(2)Number of embolized vessels in APE group was statistically significantly more than that in non-APE group,diameter of embolus and RVEDD/LVEDD ratio in APE group were statistically significantly greater than those in non-APE group,incidence of bilateral deep venous embolization,deep venous thrombosis and proximal deep venous embolization in APE group were statistically significantly higher than those in non-APE group,RVWM and TAPSE in APE group were statistically significantly smaller than those in non-APE group,moreover TRV in APE group was statistically significantly faster than that in non-APE group(P<0.05).(3)Number of embolized vessels in C group was statistically significantly more than that in A group and B group,respectively,diameter of embolus and RVEDD/LVEDD ratio in C group was statistically significantly greater than that in A group and B group,respectively,incidence of bilateral deep venous embolization and proximal deep venous embolization in C group was statistically significantly higher than that in A group and B group,respectively,RVWM and TAPSE in C group was statistically significantly smaller than that in A group and B group,respectively,moreover TRV in C group was statistically significantly faster than that in A group and B group,respectively(P<0.05);number of embolized vessels in B group was statistically significantly more than that in A group,diameter of embolus and RVEDD/LVEDD ratio in B group were statistically significantly greater than those in A group,incidence of bilateral deep venous embolization and proximal deep venous embolization in B group was statistically significantly higher than that in A group,respectively,RVWM and TAPSE in B group were statistically significantly smaller than those in A group,moreover TRV in B group was statistically significantly faster than that in A group(P<0.05).No statistically significant difference of incidence of deep venous embolization was found in groups A,B and C(P>0.05). Conclusion There are deep venous embolism of lower extremity and change of right ventricular function in patients with APE,and as risk stratification increase,severity of deep venous embolism of lower extremity aggravates and change of right ventricular function increase,thus it is necessary to carry out CTPA when we found suspected APE patients with deep venous embolism of lower extremity and change of right ventricular function on clinic,to make a definite diagnosis and clear risk stratification,eventually improve the prevention and control ability for APE.
作者
李晓花
张东光
李为
LI Xiaohua;ZHANG Dongguang;LI Wei(Department of Respiratory and Critical Care Medicine,General Hospital of Wanbei Coal and Power Group,Suzhou 234000,China;Department of Cardiology,General Hospital of Wanbei Coal and Power Group,Suzhou 234000,China)
出处
《实用心脑肺血管病杂志》
2020年第1期54-59,59,共6页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
关键词
肺栓塞
静脉血栓形成
危险分层
右心功能
Pulmonary embolism
Venous thrombosis
Risk stratification
Right heart function
作者简介
通信作者:李晓花,E-mail:Zg90958@163.com
