CAJ | 학술논문

目的探讨超声心动图联合血浆脑钠肽(brain natriuretic peptide,BNP)检测在急性肺栓塞(acute pulmonary embolism,APE)溶栓治疗中的价值.方法确诊APE且超声提示有右心压力超负荷征象患者31例进行溶栓治疗,分别在溶栓前和溶栓后24～48 h行超声、肺通气-灌注显像检查及BNP检测.结果 26例溶栓有效,溶栓后其肺动脉收缩压由(57.3±18.2)mm Hg降至(40.4±15.4)mm Hg(P=0.003),右室舒张末径由(40.6±6.1)mm减小为(35.4±6.0)mm(P＜0.01),肺动脉内径由(27.2±4.9)mm减小为(22.5±4.4)mm(P=0.004),左室舒张末径由(42.4±7.2)mm增加为(43.1±6.9)mm(P=0.42),室间隔矛盾运动者由20例减少为10例,血浆BNP由(278.8±43.3)ng/L下降为(119.1±40.4)ng/L(P=0.000 01).5例溶栓无效,溶栓前后超声心动图各参数无明显变化,但血浆BNP由(431.8±57.7)ng/L增加为(496.4±70.3)ng/L(P=0.03).血浆BNP水平与肺动脉收缩压有较好相关关系(r=0.62,P＜0.01).结论溶栓治疗能迅速改善APE患者的肺灌注和右心功能.超声联合BNP水平检测可敏感地反映溶栓治疗中的血流动力学变化,准确评价疗效.
목적 탐토초성심동도연합혈장뇌납태(brain natriuretic peptide,BNP)검측재급성폐전새(acute pulmonary embolism,APE)용전치료중적개치.방법 학진APE차초성제시유우심압력초부하정상환자31례진행용전치료,분별재용전전화용전후24～48 h행초성、폐통기-관주현상검사급BNP검측.결과 26례용전유효,용전후기폐동맥수축압유(57.3±18.2)mm Hg강지(40.4±15.4)mm Hg(P=0.003),우실서장말경유(40.6±6.1)mm감소위(35.4±6.0)mm(P＜0.01),폐동맥내경유(27.2±4.9)mm감소위(22.5±4.4)mm(P=0.004),좌실서장말경유(42.4±7.2)mm증가위(43.1±6.9)mm(P=0.42),실간격모순운동자유20례감소위10례,혈장BNP유(278.8±43.3)ng/L하강위(119.1±40.4)ng/L(P=0.000 01).5례용전무효,용전전후초성심동도각삼수무명현변화,단혈장BNP유(431.8±57.7)ng/L증가위(496.4±70.3)ng/L(P=0.03).혈장BNP수평여폐동맥수축압유교호상관관계(r=0.62,P＜0.01).결론 용전치료능신속개선APE환자적폐관주화우심공능.초성연합BNP수평검측가민감지반영용전치료중적혈류동역학변화,준학평개료효.
Objective To explore the value of combined echocardiography and brain natriuretic peptide (BNP) levels in acute pulmonary embolism (APE) treated by thrombolysis.Methods Echocardiography,pulmonary ventilation-perfusion imaging and plasma BNP levels were performed before thrombolysis and 24 - 48 h after thrombolysis in 31 patients with diagnosis of APE and signs of right ventricular pressure overload.Results Twenty-six patients with thrombolysis effective,after thrombolysis,the pulmonary artery systolic pressure decreased from (57.3 ± 18.2)mm Hg to (40.4 ± 15.4)mm Hg (P= 0.003) ,the right ventricular diastolic diameter reduced from (40.6 ± 6.1)mm to (35.4 ± 6.0)mm (P ＜0.01) ,the pulmonary artery diameter reduced from (27.2 ± 4.9)mm to (22.5 ± 4.4)mm (P = 0.004) ,the left ventricular diastolic diameter increased from (42.4 ± 7.2)mm to (43.1 ± 6.9)mm (P = 0.42),septal contradiction were reduced from 20 cases to 10 cases (P = 0.02),plasma BNP levels decreased from (278.8 ± 43.3)ng/L to (119.1 ± 40.4)ng/L (P = 0.000 01).Five patients with thrombolysis ineffective,there were no significant changes before and after thrombolytic therapy in the parameters of echocardiography,however,plasma BNP levels increased from (431.8 ± 57.7) ng/L to (496.4 ± 70.3) ng/L(P = 0.03).Plasma BNP levels and pulmonary artery systolic pressure had a better relationship(r = 0.62,P ＜0.01).Conclusions The pulmonary perfusion and right ventricular function in patients with APE can be rapidly improved by thrombolytic therapy.Combined echocardiography and the BNP levels is a sensitive index in the hemodynamic changes of thrombolytic therapy,and can evaluate the treatment accurately.