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目的探讨急性肺栓塞患者右心室流出道血流及肺动脉前向血流频谱的特点及相关参数改变的临床应用价值。方法经选择性肺动脉造影或放射性肺灌注通气扫描确诊的急性肺血栓栓塞患者77例,分为大面积和次大面积急性肺栓塞(Ⅰ组)及非大面积急性肺栓塞(Ⅱ组)。多普勒超声心动图测量右心室流出道血流加速时间(RVact)、肺动脉血流加速时间(Pact)、右心室射血时间(RVET)、右心室射血前期(RPEP)、三尖瓣反流压差(PGTI)、肺动脉前向血流速度(VP)、右心室流出道血流速度(VRVOT),计算RPEP/RVET、RPEP/RVact及RPEP/Pact。结果Ⅰ组患者的Pact、RVact、RPEP明显较Ⅱ组患者缩短(均P<0.001),PGTI则显著升高(P<0.001)。RPEP/RVact、RPEP/Pact与PGTI间具有很好的相关性(r=0.318,0.249,均P<0.05),而RPEP/RVET与PGTI间不具有相关性(r=-0.262,P>0.05)。当RVact<60 ms和Pact<70 ms或二者联合诊断RVact+Pact<70 ms时反映三尖瓣反流压差增高的敏感性最好。结论根据右心室流出道及肺动脉血流频谱形态、相关参数变化特点,可以快速判断患者右心压力改变情况,为及时诊断、快速治疗提供依据。
Objective To investigate the characteristics of right ventricular outflow tract and pulmonary artery anterior flow in patients with acute pulmonary embolism and to evaluate its clinical value. Methods Totally 77 patients with acute pulmonary thromboembolism confirmed by selective pulmonary arteriography or radiofrequency pulmonary perfusion ventilation were divided into two groups: large and minor acute pulmonary embolism (group Ⅰ) and non-large-area acute pulmonary embolism (group Ⅱ). Doppler echocardiography was used to measure RVact, Pact, RVET, RPEP, tricuspid regurgitation PGTI, VP, RVVOT and RPEP / RVET, RPEP / RVact and RPEP / Pact were calculated. Results The Pact, RVact and RPEP in group Ⅰ were significantly shorter than those in group Ⅱ (all P <0.001), and PGTI was significantly higher (P <0.001). There was a good correlation between RPEP / RVact, RPEP / Pact and PGTI (r = 0.318,0.249, all P <0.05), but not between RPEP / RVET and PGTI (r = -0.262, P> 0.05) . When RVact <60 ms and Pact <70 ms, or when the combined diagnosis of both RVact + Pact <70 ms reflects the best sensitivity of the increased tricuspid regurgitation pressure difference. Conclusion According to the characteristics of right ventricular outflow tract and pulmonary arterial blood flow spectrum and the change of related parameters, we can quickly determine the changes of right ventricular pressure and provide the basis for timely diagnosis and rapid treatment.