Xu Xinxin, Yuan Jing, Pan Xiaojie, Du Guibin, Zhang Jiahui
Department of Ultrasound, Hebei Petrochina Central Hospital, Langfang, Hebei 065000, China.
Department of Mammary Gland, Guangyang Maternal and Child Health Hospital, Langfang, Hebei, China.
Stem Cells Int. 2022 Sep 28;2022:5012613. doi: 10.1155/2022/5012613. eCollection 2022.
The study aimed to evaluate the value of bedside echocardiography (TTE) and lower extremity blood vessels in diagnosis and prognosis of acute pulmonary embolism (APE).
A retrospective study was performed on 53 patients with APE diagnosed by CT pulmonary angiography (CTPA) (systemic systolic blood pressure was >90 mmHg at time of consultation, and systemic systolic blood pressure decreased by <40 mmHg compared with basic value in those with hypertension). All patients underwent TTE examination before treatment. The high-risk factors, clinical manifestations, laboratory tests, and prognosis were retrospectively analyzed.
The rate of PE-related deterioration (cardiopulmonary resuscitation, tracheal intubation, cardiogenic shock, and death) within 14 days of hospitalization in RVD was 28%, and mortality rate (sudden death) was 20%, compared with non-RVD (both 0%). TTE examination showed that RVD as a predictor of pulmonary embolism-related death had a sensitivity of 100%, a specificity of 58%, a positive predictive value of 20%, and a negative predictive value of 100%.
(1) TTE has increasingly shown obvious advantages in diagnosis of APE. It can detect direct or indirect signs of pulmonary embolism, confirm diagnosis or suspected diagnosis, and noninvasively and dynamically observe hemodynamic changes of heart in patients with acute PTE before and after treatment.. (2) The PE-related exacerbation rate (28%) or mortality (20%) of APE patients in normotensive with RVD was higher without RVD (0%). RVD is an independent predictor of poor prognosis in normotensive acute PTE. TTE tests allow people to identify people at risk of early death. The short-term prognosis of patients without RVD was better (14 days).
本研究旨在评估床旁超声心动图（经胸超声心动图，TTE）及下肢血管检查在急性肺栓塞（APE）诊断及预后评估中的价值。
对53例经CT肺动脉造影（CTPA）确诊为APE的患者进行回顾性研究（就诊时全身收缩压>90 mmHg，高血压患者全身收缩压较基础值下降<40 mmHg）。所有患者在治疗前均接受TTE检查。对高危因素、临床表现、实验室检查及预后进行回顾性分析。
右心室功能不全（RVD）患者住院14天内发生PE相关病情恶化（心肺复苏、气管插管、心源性休克及死亡）的比例为28%，死亡率（猝死）为20%，而非RVD患者上述比例均为0%。TTE检查显示，RVD作为肺栓塞相关死亡的预测指标，灵敏度为100%，特异度为58%，阳性预测值为20%，阴性预测值为100%。
（1）TTE在APE诊断中日益显示出明显优势。它可检测肺栓塞的直接或间接征象，确诊或疑似诊断，并能无创、动态观察急性肺血栓栓塞症（PTE）患者治疗前后心脏血流动力学变化。（2）血压正常伴RVD的APE患者PE相关病情恶化率（28%）或死亡率（20%）高于无RVD患者（均为0%）。RVD是血压正常的急性PTE患者预后不良的独立预测因素。TTE检查可帮助识别早期死亡风险患者。无RVD患者的短期预后较好（14天）。
