Mansencal N, Joseph Th, Vieillard-Baron A, Qanadli S D, Digne F, Jondeau G, Lacombe P, Jardin F, Dubourg O
Service de Cardiologie, Hôpital Ambroise Paré, 9 avenue Charles de Gaulle, 92100 Boulogne, France.
Presse Med. 2002 Mar 30;31(12):541-6.
Ultrasounds are a useful tool when looking for indirect evidence in favor of pulmonary embolism. The aim of this study was to determine the incidence of acute cor pulmonale and deep venous thrombosis revealed by ultrasonographic techniques in a population of patients presenting with pulmonary embolism.
96 consecutive patients with a mean (+/- SD) age of 65 +/- 15 years, admitted to our hospital for pulmonary embolism were included in this study. The diagnosis of pulmonary embolism was made either by spiral computed tomography or selective pulmonary angiography. Each patient subsequently underwent both trans-thoracic echocardiography and venous ultrasonography. The diagnostic criterion used for defining acute cor pulmonale by echocardiography was the right to left ventricular end-diastolic area ratio over (or equal to) 0.6. Diagnosis of deep venous thrombosis was supported by the visualization of thrombi or vein incompressibility and/or the absence of venous flow or loss of flow variability by venous ultrasonography.
Using ultrasounds, an acute cor pulmonale was found in 63% of our patients while 79% were found to have deep venous thrombosis and 92% of the patients had either acute cor pulmonale or deep venous thrombosis or both. All of the patients with proximal pulmonary embolism had acute cor pulmonale and/or deep venous thrombosis. The presence of acute cor pulmonale on echocardiography was significantly higher in patients with proximal pulmonary embolism (p < 0.0001).
This study emphasizes the potential value of ultrasonographic techniques in the diagnosis of acute pulmonary embolism.
超声是寻找支持肺栓塞间接证据的有用工具。本研究的目的是确定在一组肺栓塞患者中，超声技术所揭示的急性肺心病和深静脉血栓形成的发生率。
本研究纳入了96例因肺栓塞入住我院的连续患者，平均（±标准差）年龄为65±15岁。肺栓塞的诊断通过螺旋计算机断层扫描或选择性肺血管造影进行。随后，每位患者均接受了经胸超声心动图和静脉超声检查。超声心动图定义急性肺心病的诊断标准是右心室与左心室舒张末期面积比超过（或等于）0.6。静脉超声检查发现血栓或静脉不可压缩和/或无静脉血流或血流变异性丧失支持深静脉血栓形成的诊断。
使用超声检查发现，63%的患者存在急性肺心病，79%的患者存在深静脉血栓形成，92%的患者患有急性肺心病或深静脉血栓形成或两者皆有。所有近端肺栓塞患者均有急性肺心病和/或深静脉血栓形成。近端肺栓塞患者超声心动图显示急性肺心病的发生率显著更高（p < 0.0001）。
本研究强调了超声技术在急性肺栓塞诊断中的潜在价值。
