摘要
目的探讨经胸超声心动图评价肺动脉血栓栓塞症(PTE)溶栓抗凝疗效的价值。方法对临床确诊为大面积或次大面积PTE的病人35例,应用经胸超声心动图观察溶栓抗凝治疗前及治疗后24h、2周、3个月、6个月右心系统血栓大小、右房室内径、肺动脉和三尖瓣反流频谱、下腔静脉内径的变化。结果溶栓抗凝治疗前发现右心系统血栓29例,右房、右室扩大,右室壁运动幅度降低,右室射血分数降低,肺动脉内径增宽,下腔静脉呼吸变化率减低,肺动脉频谱形态为肺动脉高压型改变,呈双峰或直角三角形,右室射血前期与右室射血时间比值(RPEP/RVET)增大,且均有不同程度的三尖瓣反流。溶栓后各时间段复查,18例血栓逐渐减小消失,9例仅余附壁小血栓,2例血栓大小未见明显变化,回声增高。溶栓后24h,右房室缩小,右室壁运动增强,肺动脉内径缩小,肺动脉压力降低,溶栓后2周继续好转,溶栓后3个月肺动脉压力属正常范围,溶栓后6个月与溶栓后3个月测值比较未见明显差异,但肺动脉血流频谱形态恢复正常。结论经胸超声心动图可作为判断PTE疗效、长期随诊的首选方法。
Objective To asscss the value of transthoracic echocardiography for the assessment of the pulmonary thromboembolism （PTE）. Methods Thirty- five patients （pts） with PTE were accepted thrornbolytic and anticoagulated treatments. The thrombus, sizes of right atria （RA） and right ventricle （RV）, inferior vena cava（IVC）, the pulsed- wave of pulmonary artery （PA） and tricuspid regurgitation （TR） were investigated by transthoracic echocardiography pre and post - treatment at 24 h, 2 w, 3 m, 6 m. Results Thrombus was found in right heart system in 29 of 35 pts pretreatment. The right heart dilatation and RV hypokinesia appeared. The RV ejection fraction （RVEF） decreased. The systolic pressure of PA （PASP） increased. The RPEP/RVET increased, TR was found. At 24 h after treatments, the thrombus became smaller and disappeared gradually. The RA, RV and PA became smaller. The PASP decreased. At 2 w, the parameters continued to improve. At 3 m, the dilatation of right ventricle was slight. At 6m the pulse - wave of PA became normal. Conclusion Transthoracic echocardiography could be the choice for evaluation of the thrombolytic treatments for PE.
出处
《中西医结合心脑血管病杂志》
2007年第9期793-794,共2页
Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease
基金
山西医科大学学生创新项目
