Huang Yun, Fei Guang-he
Department of Respiratory, the First Affiliated Hospital of Anhui Medical University, Hefei, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2012 Oct;35(10):770-4.
To analyze the value of CT pulmonary angiography (CTPA) in assessing the severity of pulmonary embolism (PE), and to investigate the correlations of the parameters from CTPA with blood gas values.
Forty-four PE patients were classified into 19 critical and 25 non-critical patients, and 37 subjects without PE were defined as control group. Right ventricular (RV) and left ventricular (LV) maximal short axis, RV to LV (RV/LV), superior vena cava and pulmonary artery diameter, obstruction index, leftward bowing of interventricular septum, reflux of contrast medium into inferior vena cava were compared among the 3 groups. The correlations of these parameters with blood gas values were investigated.
There were significant differences in RV, LV, RV/LV, superior vena cava and pulmonary artery diameter, leftward bowing of interventricular septum, reflux of contrast medium into inferior vena cava when compared among 3 groups (P < 0.05). However, significant differences were detected in RV, LV and RV/LV between critical [(53 ± 8) mm, (35 ± 6) mm, 1.56 ± 0.50] and non-critical group [(45 ± 7) mm, (43 ± 9) mm, 1.09 ± 0.31] (RV: t = 3.44, P < 0.05; LV: t = 3.08, P < 0.05; RV/LV: t = 4.62, P < 0.05), critical group and group without PE [(40 ± 7) mm, (43 ± 9) mm, 0.96 ± 0.23] (RV: t = 5.76, P < 0.05; LV: t = 3.40, P < 0.05; RV/LV: t = 6.33, P < 0.05). Superior vena cava diameter and pulmonary artery diameter were significantly different between critical group [(24 ± 4) mm, (33 ± 4) mm] and group without PE [(21 ± 4) mm, (29 ± 4) mm] (t = 2.80, P < 0.05; t = 3.98, P < 0.05). Pulmonary artery diameter in non-critical group (31 ± 5) mm was significantly different from group without PE (t = 2.59, P = 0.03). Reflux of contrast medium into inferior vena cava showed significant difference between critical group and group without PE (χ(2) = 5.54, P = 0.02). There was significant difference in obstruction index between critical (76 ± 24)% and non-critical group (52 ± 34)% (t = -2.75, P = 0.01). Obstruction index and RV/LV were negatively correlated with PaO(2) (r = -0.525, -0.502), while positively correlated with P((A-a))O(2) (r = 0.753, 0.630). Blood gas values differed significantly between above and below the 60%, 70% and 80% cutoff values of obstruction index.
Superior vena cava and pulmonary artery diameter, reflux of contrast medium into inferior vena cava can be used as indirect evidence in the diagnosis of PE, while obstruction index, RV, LV, RV/LV and leftward bowing of interventricular septum can be applied as indicators of severity of PE. The severity of the obstruction index and RV/LV assessed using CTPA are significantly correlated to the blood gas values.
分析CT肺动脉造影（CTPA）在评估肺栓塞（PE）严重程度中的价值，并探讨CTPA参数与血气值的相关性。
将44例PE患者分为危重症组19例和非危重症组25例，另将37例无PE的受试者作为对照组。比较三组的右心室（RV）和左心室（LV）最大短轴、RV与LV（RV/LV）、上腔静脉和肺动脉直径、梗阻指数、室间隔向左弯曲、造影剂反流至下腔静脉情况。研究这些参数与血气值的相关性。
三组间RV、LV、RV/LV、上腔静脉和肺动脉直径、室间隔向左弯曲、造影剂反流至下腔静脉情况比较，差异有统计学意义（P<0.05）。然而，危重症组[（53±8）mm，（35±6）mm，1.56±0.50]与非危重症组[（45±7）mm，（43±9）mm，1.09±0.31]之间的RV、LV和RV/LV差异有统计学意义（RV：t=3.44，P<0.05；LV：t=3.08，P<0.05；RV/LV：t=4.62，P<0.05），危重症组与无PE组[（40±7）mm，（43±9）mm，0.96±0.23]之间也有差异（RV：t=5.76，P<0.05；LV：t=3.40，P<0.05；RV/LV：t=6.33，P<0.05）。危重症组[（24±4）mm，（33±4）mm]与无PE组[（21±4）mm，（29±4）mm]的上腔静脉直径和肺动脉直径差异有统计学意义（t=2.80，P<0.05；t=3.98，P<0.05）。非危重症组肺动脉直径（31±5）mm与无PE组差异有统计学意义（t=2.59，P=0.03）。造影剂反流至下腔静脉情况在危重症组与无PE组间差异有统计学意义（χ(2)=5.54，P=0.02）。危重症组梗阻指数（76±24）%与非危重症组（52±34）%差异有统计学意义（t=-2.75，P=0.01）。梗阻指数和RV/LV与PaO(2)呈负相关（r=-0.525，-0.502），而与P((A-a))O(2)呈正相关（r=0.753，0.6
