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1. 承德医学院附属医院超声科
2. 承德医学院附属医院内分泌科
纸质出版日期:2020,
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[1]秦诗阳,房亮,曹雪松,张蕊,刘会玲.超声心动图评价急性肺栓塞患者溶栓前后左室舒张功能[J].临床超声医学杂志,2020,22(11):829-833.
QIN Shiyang, FANG Liang, CAO Xuesong, et al. Evaluation of left ventricular diastolic function in patients with acute pulmonary embolism before and after thrombolysis by echocardiography[J]. Journal of Clinical Ultrasound in Medicine, 2020,22(11):829-833.
[1]秦诗阳,房亮,曹雪松,张蕊,刘会玲.超声心动图评价急性肺栓塞患者溶栓前后左室舒张功能[J].临床超声医学杂志,2020,22(11):829-833. DOI: 10.16245/j.cnki.issn1008-6978.2020.11.010.
QIN Shiyang, FANG Liang, CAO Xuesong, et al. Evaluation of left ventricular diastolic function in patients with acute pulmonary embolism before and after thrombolysis by echocardiography[J]. Journal of Clinical Ultrasound in Medicine, 2020,22(11):829-833. DOI: 10.16245/j.cnki.issn1008-6978.2020.11.010.
目的应用超声心动图评价急性肺栓塞(APE)患者溶栓前后左室舒张功能。方法选取我院经计算机断层摄影肺血管造影(CTPA)确诊的肺动脉栓塞患者87例
入院时均行急诊超声心动图检查
根据左室舒张功能分为舒张功能正常组(22例)、舒张功能降低Ⅰ级组(31例)、舒张功能降低Ⅱ级组(20例)及舒张功能降低Ⅲ级组(14例)。比较各组溶栓前后肺动脉收缩压(PASP)、三尖瓣反流峰值压差(TRPG)、右心解剖形态指标及左室舒张功能指标;分析溶栓前后左室舒张功能指标与PASP的相关性。结果溶栓前
各组二尖瓣口舒张早期峰值血流速度(E)与舒张晚期峰值血流速度比值(E/A)、E与二尖瓣瓣环舒张早期峰值运动速度比值(E/e’)、舒张早期与晚期左室充盈速率比值(VER/VAR)、舒张早期与晚期左室充盈容积比值(VE/VA)比较
差异均有统计学意义(均P<0.05);溶栓后
舒张功能减低Ⅱ级组、Ⅲ级组E/A均明显低于溶栓前
舒张功能减低Ⅰ级组、Ⅱ级组、Ⅲ级组E/e’均明显低于溶栓前
VER/VAR、VE/VA均明显高于溶栓前
差异均有统计学意义(均P<0.05);舒张功能减低Ⅰ级组E/A溶栓前后比较差异均无统计学意义。溶栓后各组患者PASP、TRPG、右室舒张末期前后径(RVED)、右室前壁厚度(RVAWT)、主肺动脉内径(PAD)均低于溶栓前
差异均有统计学意义(均P<0.05)。溶栓前PASP与E/A呈正弱相关(r=0.293
P=0.031)
与VER/VAR、VE/VA均呈负低度相关(r=-0.450、-0.471
P=0.011、0.013)
与E/e’呈中度正相关(r=0.572
P=0.011);溶栓后PASP与E/A呈正弱相关(r=0.107
P=0.039)
与VER/VAR、VE/VA均呈负弱相关(r=-0.229、-0.235
P=0.037、0.036)
与E/e’呈正性低度相关(r=0.362
P=0.030)。结论超声心动图可通过评价APE患者左室舒张功能评估溶栓治疗效果。
ObjectiveTo evaluate left ventricular diastolic function in patients with acute pulmonary embolismbefore and after thrombolysis by echocardiography.MethodsEighty-seven patients with pulmonary embolism confirmed bycomputed tomographic pulmonary angiography(CTPA)in our hospital were selected. All patients were examined by emergencyechocardiography on admission. According to left ventricular diastolic function
they were divided into 4 groups:normal diastolicfunction group(n=22)
reduced diastolic function grade Ⅰ group(n=31)
reduced diastolic function grade Ⅱ group(n=20)andreduced diastolic function grade Ⅲ group(n=14). Pulmonary artery systolic pressure(PASP)
tricuspid regurgitation pressuregradient(TRPG)
anatomical morphological index of right heart and left ventricular diastolic function before and afterthrombolysis were compared among groups.The correlation between PASP and parameters of left ventricular diastolic functionbefore and after thrombolysis was analyzed.ResultsThe ratio of mitral valve early diastolic peak flow velocity(E)and the latediastolic peak flow velocity(E/A)
the ratio of E and mitral valve ring early diastolic peak velocity(E/e’)
the ratio of early andlate diastolic left ventricular filling rate(VER/VAR)
the ratio of the early and late diastolic left ventricular filling volume(VE/VA)were statistically different before thrombolysis among groups(all P<0.05).After thrombolysis
the E/A in grade Ⅱand Ⅲ groups were significantly lower than those before thrombolysis(both P<0.05).The E/e’in grade Ⅰ
Ⅱ
and Ⅲ groupsafter thrombolysis were significantly lower than those before thrombolysis
VER/VAR and VE/VA were significantly higher thanthose before thrombolysis
the differences were statistically significant(all P<0.05). There was no statistically significantdifference in E/A before and after thrombolysis in the grade Ⅰ group.After thrombolysis
the PASP
TRPG
right ventricular enddiastolic diameter(RVED)
right ventricular anterior wall thickness(RVAWT)and main pulmonary artery inner diameter(PAD)of patients in each group were significantly lower than those before thrombolysis
and the differences were statistically significant(all P<0.05). Before thrombolysis
PASP was positively and weakly correlated with E/A(r=0.293
P=0.031)
negativelycorrelated with VER/VAR and VE/VA(r =-0.450
-0.471
P=0.011
0.013)
moderately and positively correlated with E/e’(r=0.572
P=0.011). After thrombolysis
PASP was positively and weakly correlated with E/A(r=0.107
P=0.039)
negativelyand weakly correlated with VER/VAR
VE/VA(r =-0.229
-0.235
P=0.037
0.036)
and positively and lowly correlated withE/e’(r=0.362
P=0.030).ConclusionEchocardiography can evaluate the effect of thrombolytic therapy by evaluating leftventricular diastolic function in patients with acute pulmonary embolism.
超声心动描记术急性肺栓塞舒张功能心室左肺动脉收缩压
EchocardiographyAcute pulmonary embolismDiastolic functionventricleleftPulmonary artery systolic pressure
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