肺栓塞%治疗%心室功能,左
肺栓塞%治療%心室功能,左
폐전새%치료%심실공능,좌
Pulmonary embolism%Treatment%Ventricular function,left
目的 应用前后对照设计评价溶栓治疗以及肝素抗凝治疗是否可以有效改善急性肺血栓栓塞症(PTE)引起的左心室结构与功能改变.方法 收集2006年1月至2011年6月北京安贞医院急诊重症监护病房的住院急性PTE患者71例,其中男36例,女35例,平均年龄(64±13)岁；分为溶栓治疗组(37例)和肝素抗凝治疗组(34例).溶栓组患者治疗前及溶栓结束后24h内分别完成经胸多普勒超声心动评价,肝素抗凝组治疗前及肝素抗凝治疗5～7d后,均行多普勒超声心动图检查.同期收集来自同一医院体检中心的健康体检者51名,设为对照组,其中男29名,女22名,平均年龄(61±9)岁.经胸多普勒超声测量左心室舒张末期与收缩末期内径,计算左心室射血分数；测量左心室舒张早期(E)和左心房收缩期(A)二尖瓣前向血流速度,并应用E/A比值反映舒张早期与心房收缩期血流对左心室舒张充盈的相对贡献.结果 急性PTE患者治疗前,左心室舒张末期内径[(42±5) mm]显著低于对照组[(46±5)mm,t=3.629,P＜0.01],左心室舒张期E峰流速及E/A比值(0.8±0.3)显著低于对照组(1.2±0.3,t值分别为5.296,6.510,P＜0.01),A峰流速显著高于对照组(t =3.065,P＜0.05).与治疗前相比,治疗后PTE患者左心室舒张末期[(46±5)mm]与收缩末期内径[(30±6) mm]均明显增加(t值分别为5.284,3.983,P＜0.01),左心室舒张期E峰流速及E/A比值显著改善(t值分别为3.452,2.604,P＜0.05).两治疗组分别与治疗前比较结果显示,患者左心室舒张末期内径(t值分别为4.145,3.269)与收缩末期内径(t值分别为2.896,2.761)均明显增加(均P＜0.05),左心室舒张期E峰流速均显著提高(t值分别为2.505,2.492,均P＜0.05).治疗后PTE患者左心室舒张期E峰流速以及E/A比值仍显著低于健康对照(t值分别为2.615,3.837,均P＜0.01),A峰流速仍高于健康对照者(t=3.290,P＜0.01).结论 有效的溶栓治疗或肝素抗凝治疗可以改善急性PTE患者左心室功能.
目的 應用前後對照設計評價溶栓治療以及肝素抗凝治療是否可以有效改善急性肺血栓栓塞癥(PTE)引起的左心室結構與功能改變.方法 收集2006年1月至2011年6月北京安貞醫院急診重癥鑑護病房的住院急性PTE患者71例,其中男36例,女35例,平均年齡(64±13)歲；分為溶栓治療組(37例)和肝素抗凝治療組(34例).溶栓組患者治療前及溶栓結束後24h內分彆完成經胸多普勒超聲心動評價,肝素抗凝組治療前及肝素抗凝治療5～7d後,均行多普勒超聲心動圖檢查.同期收集來自同一醫院體檢中心的健康體檢者51名,設為對照組,其中男29名,女22名,平均年齡(61±9)歲.經胸多普勒超聲測量左心室舒張末期與收縮末期內徑,計算左心室射血分數；測量左心室舒張早期(E)和左心房收縮期(A)二尖瓣前嚮血流速度,併應用E/A比值反映舒張早期與心房收縮期血流對左心室舒張充盈的相對貢獻.結果 急性PTE患者治療前,左心室舒張末期內徑[(42±5) mm]顯著低于對照組[(46±5)mm,t=3.629,P＜0.01],左心室舒張期E峰流速及E/A比值(0.8±0.3)顯著低于對照組(1.2±0.3,t值分彆為5.296,6.510,P＜0.01),A峰流速顯著高于對照組(t =3.065,P＜0.05).與治療前相比,治療後PTE患者左心室舒張末期[(46±5)mm]與收縮末期內徑[(30±6) mm]均明顯增加(t值分彆為5.284,3.983,P＜0.01),左心室舒張期E峰流速及E/A比值顯著改善(t值分彆為3.452,2.604,P＜0.05).兩治療組分彆與治療前比較結果顯示,患者左心室舒張末期內徑(t值分彆為4.145,3.269)與收縮末期內徑(t值分彆為2.896,2.761)均明顯增加(均P＜0.05),左心室舒張期E峰流速均顯著提高(t值分彆為2.505,2.492,均P＜0.05).治療後PTE患者左心室舒張期E峰流速以及E/A比值仍顯著低于健康對照(t值分彆為2.615,3.837,均P＜0.01),A峰流速仍高于健康對照者(t=3.290,P＜0.01).結論 有效的溶栓治療或肝素抗凝治療可以改善急性PTE患者左心室功能.
목적 응용전후대조설계평개용전치료이급간소항응치료시부가이유효개선급성폐혈전전새증(PTE)인기적좌심실결구여공능개변.방법 수집2006년1월지2011년6월북경안정의원급진중증감호병방적주원급성PTE환자71례,기중남36례,녀35례,평균년령(64±13)세；분위용전치료조(37례)화간소항응치료조(34례).용전조환자치료전급용전결속후24h내분별완성경흉다보륵초성심동평개,간소항응조치료전급간소항응치료5～7d후,균행다보륵초성심동도검사.동기수집래자동일의원체검중심적건강체검자51명,설위대조조,기중남29명,녀22명,평균년령(61±9)세.경흉다보륵초성측량좌심실서장말기여수축말기내경,계산좌심실사혈분수；측량좌심실서장조기(E)화좌심방수축기(A)이첨판전향혈류속도,병응용E/A비치반영서장조기여심방수축기혈류대좌심실서장충영적상대공헌.결과 급성PTE환자치료전,좌심실서장말기내경[(42±5) mm]현저저우대조조[(46±5)mm,t=3.629,P＜0.01],좌심실서장기E봉류속급E/A비치(0.8±0.3)현저저우대조조(1.2±0.3,t치분별위5.296,6.510,P＜0.01),A봉류속현저고우대조조(t =3.065,P＜0.05).여치료전상비,치료후PTE환자좌심실서장말기[(46±5)mm]여수축말기내경[(30±6) mm]균명현증가(t치분별위5.284,3.983,P＜0.01),좌심실서장기E봉류속급E/A비치현저개선(t치분별위3.452,2.604,P＜0.05).량치료조분별여치료전비교결과현시,환자좌심실서장말기내경(t치분별위4.145,3.269)여수축말기내경(t치분별위2.896,2.761)균명현증가(균P＜0.05),좌심실서장기E봉류속균현저제고(t치분별위2.505,2.492,균P＜0.05).치료후PTE환자좌심실서장기E봉류속이급E/A비치잉현저저우건강대조(t치분별위2.615,3.837,균P＜0.01),A봉류속잉고우건강대조자(t=3.290,P＜0.01).결론 유효적용전치료혹간소항응치료가이개선급성PTE환자좌심실공능.
Objective The purpose of the present study mainly aimed to evaluate whether thrombolysis and heparin anticoagulation for acute pulmonary thromboembolism (PTE) could improve the abnormal left ventricular diastolic filling induced by acute PTE.Methods A total of 71 acute PTE patients (36 males and 35 females; age 64 ± 13 years,range 24 -87 years) admitted to the emergency intensive care unit of Beijing Anzhen Hospital were consecutively recruited from January of 2006 to June of 2011.Fifty-one age-and gender-matched healthy controls (29 males and 22 females,age 61 ±9 years,range 31 -79 years)were also recruited from Health Center during the same period of time.PTE patients were classified into 2 treatment subgroups according to initial therapy,thrombolysis subgroup (n =37 ) and direct anticoagulation subgroup with heparin (n =34 ). Pre- and post-treatment,trans-thoracic Doppler echocardiography was used to assess left ventricular diameters and diastolic filling patterns.Trans-mitral flow velocities including early (E) and late atrial (A) filling velocities were measured,and E/A ratio was calculated reflecting the relative contribution of early and atrial filling.Results Compared with healthy controls,patients with acute PTE had significantly smaller left ventricular end-diastolic diameter ( t =3.629,P＜0.001),lower mitral E velocity and E/A ratio (t =5.296,6.510,both P ＜0.001 ),and higher A velocity ( t =3.065,P ＜ 0.01 ).After initial treatment including thrombolysis and direct anticoagulation with heparin for all patients with acute PTE,left ventricular end-diastolic diameter and end-systolic diameter were enlarged significantly ( t =5.284,3.983,both P ＜ 0.001 ),and mitral E velocity and E/A ratio were increased significantly (t =3.452,2.604,P ＜0.05,respectively).Subgroup analysis revealed that,both thrombolytic therapy and anticoagulation with heparin could significantly enlarge left ventricular end-diastolic diameter ( t =4.145,3.269,respectively) and end-systolic diameter ( t =4.145,3.269,respectively,all P ＜ 0.050),and increase mitral E velocity ( t =2.505,2.492,P ＜ 0.05,respectively).Compared with healthy controls,even after initial treatment with thrombolysis or heparin anticoagulation,PTE patients still showed lower mitral E velocity and E/A ratio ( t =2.615,3.837,P ＜ 0.05,respectively ),and higher A velocity (t =3.290,P ＜ 0.01 ).Conclusion The results strongly suggest that initial treatment for acute PTE with thrombolysis and heparin anticoagulation could improve the abnormal left ventricular diastolic filling induced by acute PTE.
