【摘要】 目的探讨经胸超声心动图（TTE）在评价血压正常急性肺栓塞（APE）患者预后中的应用价值。方法就诊时血压正常的APE患者53例,TTE检出右心室扩张、肺动脉高压等间接征象作为急性右心功能不全的诊断标准,将患者分为急性右心功能不全组25例和右心功能正常组28例,对两组临床情况进行回顾分析。结果 TTE发现右心房、右心室或肺动脉内血栓7例。急性右心功能不全组与右心功能正常组在年龄、性别和高危因素方面差异无统计学意义（均为P>0.05）。在呼吸困难、就诊时心率、颈静脉怒张、P2亢进、血气分析指标（PCO₂除外）和TTE检查指标方面,两组比较差异均有统计学意义（均为P<0.05）。右心功能不全组与正常组住院14d的肺栓塞相关病死率为20%比0%,预后不良发生率为28%比0%,差异均有统计学意义（均为P<0.05）。右心功能不全组经抗凝治疗后,20例复查血气分析和TTE,与治疗前比较差异均有统计学意义（均为P<0.05）。TTE检查示右心功能不全可作为肺栓塞相关死亡的预测指标,其敏感度为100%,特异度为58%,阳性预测值20%,阴性预测值100%。结论 TTE可无创评估右心功能状况。右心功能不全是APE高病死率和不良预后的识别指标,TTE可识别出具有早期死亡风险的人群。右心功能正常患者短期预后较好。更多还原

【Abstract】 Objective To evaluate prognostic value of transthoracic echocardiography （TTE） in normotensive acute pulmonary embolism （APE） patients.Methods Fifty-three normotensive patients were identified as APE on admission.All patients were divided into two groups:group Ⅰ（normal right ventricular function） and group Ⅱ（right ventricular dysfunction）.The clinical data of these two groups were analyzed.Acute right ventricle dysfunction （RVD） was diagnosed if TTE showed one or more of the following indirect signs,such as RV dilatation,pulmonary artery hypertension. Results Thrombi in right heart or pulmonary artery were visualized by TTE in 7 cases.There were no differences in age, gender,the prevalence of DVT,history of smoking and cancer between two groups （P>0.05）.There were significant differences in dyspnea,tachycardia,jugular engorgement,accentuated P2,indicator of arterial blood gas analysis （except PCO₂） and the main indexes between the two groups.In group Ⅱ,PE-related in-hospital deterioration rate （28%） or mortality （20%） were significant higher than in group Ⅰ（P<0.05）.RV function and arterial blood gas analysis were improved in short-term （P<0.05）.The sensitivity and negative predictive value of echocardiography for PE-related death was 100% in this particular patient population,although its specificity and positive predictive value were low.Conclusions TIE is a helpful non-invasive tool to evaluate RVD which is related to poor prognosis .Normotensive patients without RVD have a relatively benign short-term prognosis.更多还原