心力衰竭合并急性肺栓塞时血栓负荷与临床表现的相关性

doi:10.3969/j.issn.1002-1949.2018.10.002

摘要
图/表
参考文献(18)
相关文章 (5)

全文: PDF (1039 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨心力衰竭合并肺栓塞（pulmonary embolism, PE）时血栓负荷与右室功能不全（right ventricular dysfunction, RVD）的相关性。方法选择首次发病的急性中危PE患者，根据既往是否存在心功能不全病史分为存在心功能不全PE组（Ⅰ组）和无心功能不全PE组（Ⅱ组）。由两位经验丰富的医学影像医师读取肺动脉增强CT（computed tomography pulmonary arteriography， CTPA）中肺动脉的阻塞指数（obstruction score， OS）和右心室/左心室（RV/LV）。结果最终入选152例急性中危PE患者，其中Ⅰ组35例（23%），Ⅱ组117例（77%）。两组OS（Ⅰ组29.4%，Ⅱ组32.4%，P=0.083）、呼吸频率及心率比较差异均无统计学意义（P>0.05）；Ⅰ组LVEF显著低于Ⅱ组（Ⅰ组35.4%，Ⅱ组 65.0%，P<0.000），Ⅰ组低血压（P=0.031）、高脂血症（P=0.034）、冠状动脉粥样硬化性心脏病（P=0.045）、慢性肾病（P=0.024）和肺动脉高压（P=0.025）的比例显著高于Ⅱ组（P<0.05）；Ⅰ组氧合指数、RV/LV和平均动脉压（mean blood pressure， MBP）均低于Ⅱ组（Ⅰ组285.9，Ⅱ组328.5，P<0.000；Ⅰ组0.91，Ⅱ组1.39，P<0.000；Ⅰ组62.2 mm Hg，Ⅱ组65.8 mm Hg，P=0.002）。Ⅰ组OS与RV/LV无显著相关性（r=0.086，P=0.962），与HR（r=0.010，P=0.542）、RR（r=0.132，P=0.192）无显著相关性（P>0.05），与氧合指数呈显著负相关（r=-0.637，P=0.025），与MBP呈显著负相关（r=-0.610，P=0.036）。Ⅱ组OS与RV/LV呈显著正相关（r=0.624，P=0.000），与氧合指数（r=-0.473，P=0.032）和MBP（r=-0.570，P=0.036）呈中度负相关（P<0.05），与HR（r=0.266，P=0.025）及RR（r=0.321，P=0.028）的相关性较弱。结论对于阻塞程度相同条件下的PE患者，右室功能不全作为间接判断PE阻塞严重程度的指标能否反映患者病情的严重程度，取决于患者原有的左心功能状态。存在左心功能不全时，右室功能不全尚不能反映血栓负荷程度。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	王丹丹
	米玉红
	马晓海
	赵蕾

关键词 ：急性肺栓塞, 心力衰竭/心功能不全, 肺动脉阻塞指数/肺血栓负荷, 右室功能不全, 临床表现

基金资助:北京市教育委员会科技发展计划一般项目（KM201710025016）

通讯作者: 米玉红（1965-），女，主任医师，硕士生导师，E-mail：myhicu@163.com。

作者简介: 王丹丹（1993-），女，硕士，E-mail：13521993468@163.com。

引用本文:

王丹丹，米玉红，马晓海，赵蕾. 心力衰竭合并急性肺栓塞时血栓负荷与临床表现的相关性[J]. 中国急救医学, 2018, 38(10): 837-841.
Wang Dan-dan, Mi Yu-hong, Ma Xiao-hai, Zhao Lei. Correlation between clot burden and clinical presentations in patients with acute pulmonary embolism and heart failure. Chinese Journal of Critical Care Medicine, 2018, 38(10): 837-841.

链接本文:

http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2018.10.002 或 http://www.cnemergency.org.cn/CN/Y2018/V38/I10/837

［1］van der Meer RW, Pattynama PM, van Strijen MJ, et al. Right ventricular dysfunction and pulmonary obstruction index at helical CT: prediction of clinical outcome during 3-month follow-up in patients with acute pulmonary embolism［J］. Radiology, 2005, 235(3): 798-803. ［2］Remy-Jardin M, Pistolesi M, Goodman LR, et al. Management of suspected acute pulmonary embolism in the era of CT angiography:a statement from the Fleischner Society［J］. Radiology, 2007, 245(2): 315-329. ［3］Furlan A, Aghayev A, Chang CC, et al. Short-term mortality in acute pulmonary embolism: clot burden and signs of right heart dysfunction at CT pulmonary angiography［J］. Radiology, 2012, 265(1): 283-293. ［4］Park CY, Yoo SM, Rho JY, et al. The Ratio of Descending Aortic Enhancement to Main Artery Enhancement Measured on Pulmonary CT Angiography as Finding to Predict Poor Outcome in Patients with Massive or Submassive Pulmonary Embolism［J］. Tuberc Respir Dis(Seoul), 2012, 72(4): 352-359. ［5］Rodrigues AC, Guimaraes L, Guimaraes JF, et al. Relationship of clot burden and echocardiographic severity of right ventricular dysfunction after acute pulmonary embolism［J］. Int J Cardiovasc Imaging, 2015, 31(3): 509-515. ［6］Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)［J］. Eur Heart J, 2008, 29(18): 2276-2315. ［7］Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER)［J］. Lancet, 1999, 353(9162): 1386-1389. ［8］Qanadli SD, El Hajjam M, Vieillard-Baron A, et al. New CT index to quantify arterial obstruction in pulmonary embolism:comparison with angiographic index and echocardiography［J］. AJR Am J Roentgenol, 2001, 176(6): 1415-1420. ［9］IBM(2013) IBM SPSS statistics for Windows［CP］. IBM corp, Armonk, USA. ［10］Manier G, Castaing Y, Guenard H. Determinants of hypoxemia during the acute phase of pulmonary embolism in humans［J］. Am Rev Respir Dis, 1985, 132(2): 332-338. ［11］Smulders YM. Pathophysiology and treatment of haemodynamic instability in acute pulmonary embolism: the pivotal role of pulmonary vasoconstriction［J］. Cardiovasc Res, 2000, 48(1): 23-33. ［12］Marcus JT, Gan CT, Zwanenburg JJ, et al. Interventricular mechanical asynchrony in pulmonary arterial hypertension: left-to-right delay in peak shortening is related to right ventricular overload and left ventricular underfilling［J］. J Am Coll Cardiol, 2008, 51(7): 750-757. ［13］Mauritz GJ, Marcus JT, Westerhof N, et al. Prolonged right ventricular post-systolic isovolumic period in pulmonary arterial hypertension is not a reflection of diastolic dysfunction［J］. Heart, 2011, 97(6): 473-478.  ［14］Kurzyna M, Torbicki A, Pruszczyk P, et al. Disturbed right ventricular ejection pattern as a new Doppler echocardiographic sign of acute pulmonary embolism［J］. Am J Cardiol, 2002, 90(5): 507-511. ［15］Cho JH, Kutti Sridharan G, Kim SH, et al. Right ventricular dysfunction as an echocardiographic prognostic factor in hemodynamically stable patients with acute pulmonary embolism: a meta-analysis［J］. BMC Cardiovasc Disord, 2014, 14: 64. ［16］Ghaye B, Ghuysen A, Willems V, et al. Severe pulmonary embolism: pulmonary artery clot load scores and cardiovascular parameters as predictors of mortality［J］. Radiology, 2006, 239(3): 884-891. ［17］Kang DK, Thilo C, Schoepf UJ, et al. CT signs of right ventricular dysfunction: prognostic role in acute pulmonary embolism［J］. JACC Cardiovasc Imaging, 2011, 4: 841-849. ［18］Miller RL, Das S, Anandarangam T, et al. Association between right ventricular function and perfusion abnormalities in hemodynamically stable patients with acute pulmonary embolism［J］. Chest, 1998, 113(3): 665-670.