【摘要】 目的 探讨双源CT在诊断肺栓塞中的价值。 方法 2008年5月－2010年12月纳入50例可疑肺栓塞患者，使用双源CT进行肺动脉血管增强扫描，对图像行三维重建，分析栓塞部位、栓子形态、肺内、心脏及胸腔改变等。 结果 44例确诊肺栓塞，发现肺栓塞共260处，最常见于右肺下叶动脉28例（63.0%），其次于右肺动脉22例（50.0%）、左肺下叶动脉19例（43.2%）；15例（34.1%）累及亚段肺动脉；右肺动脉受累较左肺动脉常见（Plt;0.05）。39例系急性肺栓塞（88.6%），5例系慢性肺栓塞（11.4%）。 结论 双源CT扫描速度快，空间分辨率高，可以准确显示肺栓塞部位，并且可以同时评价胸腔、肺内及心脏的变化。在临床上，双源CT可以作为肺栓塞的首选检查。【Abstract】 Objective To explore the value of dual-source CT in diagnosing pulmonary embolism. Methods From May 2008 to December 2010, 50 patients who were suspected of pulmonary embolism were included, and pulmonary angiography was performed on these patients by dual-source CT. The obtained images were reconstructed with three dimensional technique to analyze the location and shape of the embolism, and lesions affecting the lung, heart and thoracic cavity. Results A total of 44 patients wiht pulmonary embolism with 260 affected branches of arteries were confirmed by CT angiography. The most common affecting artery was the right lower pulmonary artery(28/44,63.0%), which was followed by the right pulmonary artery (22/44,50.0%) and the left lower pulmonary artery(19/44,43.2%). Segmental and subsegmental pulmonary arteries were involved in 15 patients (15/44, 34.1%). Pulmonary artery embolism involves the right pulmonary arteries more frequently than the left pulmonary arteries (P＜0.05).Acute pulmonary embolism was found in 39 cases(39/44, 88.6%), while chronic pulmonary embolism was found in 5(5/44, 11.4%). Conclusions Dual-source CT with fast scanning speed and high spatial resolution can demonstrate the exact site of the pulmonary embolism and evaluate the lesions of thoracic cavity, lung and heart. In clinical practice, dual-source CT could be the preferred choice in diagnosing pulmonary embolism.
ObjectiveTo systematic review the diagnostic value of magnetic resonance (MR) for pulmonary embolism (PE).MethodsWe electronically searched databases including EMbase, PubMed, The Cochrane Library, WanFang Data and CNKI from inception to November 2016, to collect the diagnostic studies about MR in the diagnosis of PE. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the risk of bias of included studies, and then meta-analysis was conducted using Stata 12.0 software.ResultsA total of 14 studies involving 1 042 patients were included. The pooled Sen, Spe, +LR, –LR and DOR were 0.90 (95%CI 0.83 to 0.94), 0.95 (95%CI 0.90 to 0.98), 19.8 (95%CI 8.5 to 46.1), 0.10 (95%CI 0.06 to 0.18), 189 (95%CI 69 to 521), respectively. The AUC of SROC were 0.97 (95%CI 0.95 to 0.98).ConclusionMR has a good diagnosis value for PE which can be regarded as an effective and feasible method for suspected PE patients, especially for those who has contraindication of computed tomographic pulmonary angiography.
ObjectiveTo investigate the anticoagulant drug treatment decision for patients with renal contusion and acute pulmonary embolism, and to enhance the level of treatment for this disease. MethodsA retrospective analysis of the clinical data of a patient with renal contusion and acute pulmonary embolism treated at the West China Hospital of Sichuan University, along with a relevant literature review. Databases including PubMed, Ovid Medline, Embase, VIP, Wanfang and Chinese National Knowledge infrastructure were searched using the keywords as “Pulmonary embolism” AND “Hemorrhage”from January 1983 to December 2023. ResultThe patient was a 21-year-old male who presented with right kidney contusion for 5 days and dyspnea for 1 day. The abdominal CT scan revealed a ruptured right kidney accompanied by hemorrhage and hematoma in the surrounding tissue. Abdomen ultrasound: a low echogenic area measuring approximately 10.6 cm×2.8 cm is noted around the right kidney. The CT pulmonary angiography (CTPA) demonstrated filling defects at the bifurcation of the pulmonary trunk, as well as within the upper and lower lobes of both lungs and their respective branches. The blood gas analysis of patient indicated (face mask oxygen therapy at 10 L/min, oxygenation index of 120): pH 7.456, PCO2 24.9 mm Hg, PO2 73.2 mm Hg. His myocardial markers were Myoglobin: 79.21 ng/ml, Troponin T: 58.7 ng/L, BNP: 2062 ng/L. The patient was diagnosed with renal contusion and pulmonary embolism, and was treated with subcutaneous heparin（initial dose is given as an 80 IU/kg intravenous bolus, followed by a continuous infusion of 12-18 IU/kg/h） and low-molecular-weight heparin at a dose of 0.8 ml every 12 hours one after another for anticoagulation, along with symptomatic treatment. Following the intervention, the patient's respiratory distress showed significant improvement, and subsequent arterial blood gas analysis indicated enhanced oxygenation. Then, the anticoagulant medication was adjusted to oral rivaroxaban anticoagulation for 6 months, follow-up CTPA scan revealed complete resolution of the pulmonary embolism and the abdominal CT scan indicated a reduction in the extent of patchy low-density shadows surrounding the right kidney, leading to the discontinuation of anticoagulation therapy. After searching the above-mentioned databases, total of 26 articles were identified that reported on 30 patients diagnosed with high-risk bleeding and acute pulmonary embolism; among these, 3 patients succumbed while 27 exhibited clinical improvement. ConclusionsPatients with renal contusion and acute pulmonary embolism can be safely and effectively treated with low-dose heparin anticoagulation under close monitoring. High-risk bleeding patients with acute pulmonary embolism present a significant challenge in clinical practice. After weighing the risks of bleeding disorders and the adverse outcomes of pulmonary embolism, it is necessary to find the optimal balance between anticoagulation and bleeding. Consequently, the formulation of personalized treatment strategies in accordance with established guidelines can enhance patient outcomes.
【摘要】 目的 观察经皮导管介入治疗急性肺栓塞的疗效。 方法 选择2003年1月-2009年6月收治的急性肺栓塞患者15例，采用经皮导管吸栓术、碎栓术及溶栓术治疗。溶栓术用局部灌注加即刻静脉注射尿激酶，总量100万U。溶栓后给予低分子肝素7~10 d，口服华法林3~6个月。观察临床症状、体征改善情况、并发症、平均肺动脉压（mPAP）与动脉血氧分压（PO2）的变化，以及肺动脉开通情况。 结果 12例肺动脉完全开通，3例部分开通，显效率89%，有效率100%。mPAP从（41.07±6.97） mm Hg降到（21.00±5.66） mm Hg，PO2从（46.26±9.30） mm Hg升到（79.49±8.04） mm Hg，治疗前后差异有统计学意义（Plt;0.05）。即刻临床症状明显改善，mPAP迅速降低11例。随访3~6个月，疗效持续，未见复发。 结论 介入治疗急性肺栓塞疗效显著，安全可行，对抢救危重患者、改善临床症状、维持血流动力学稳定有重要作用。【Abstract】 Objective To observe the clinical curative effect on acute pulmonary embolism(PE)via percutaneous catheter intervention. Methods Fifteen acute PE patients admitted from January 2003 to June 2009 were treated with percutaneous catheter drawing of thrombus, thrombectomy, and thrombolysis. Local infusion and immediate intra-venous injection of urokinase with 100 000 000 U in total were used for thrombolysis. Afterwards, the low molecular weight heparin was given for seven to ten days, and an oral intake of warfarin lasts for three to six months. Observe the clinical symptoms, improvement of physical signs, occurrence of complications, change of mean pulmonary arterial pressure (mPAP) and arterial partial pressure of oxygen (PO2), as well as the patency condition of pulmonary artery. Results Twelve of fifteer patients gained complete patency of pulmonary artery, and the other three patients gained partial patency, with an obvious effectiveness rate of 89% and an effectiveness rate of 100%. mPAP decreased from (41. 07±6. 97) mm Hg to (21. 00±5. 66) mm Hg, and PO2 elevated from (46. 26±9. 30) mm Hg to (79. 49±8. 04) mm Hg, showing a significant difference (Plt;0. 05) before and after the therapy. The immediate clinical symptoms exhibited a significant improvement. The pulmonary artery pressure of 11 patients dropped rapidly. During three to six months’ follow up, the therapeutic effects persisted and no recurrence was found. Conclusion The interventional treatment of acute PE demonstrates remarkable effectiveness, safety and feasibility, which plays an important role in the rescue of critical patients, improvement of clinical symptoms, and maintenance of hemodynamic stability.
Objective To investigate the prognostic value of B-type natriuretic peptide (BNP) for short-term all-cause mortality in patients with acute pulmonary embolism (APE). Methods Such databases as PubMed, EMbase, Central Register of Controlled Trials, CBM, and CNKI (from the date of their establishments to March 2010) were searched. The level of BNP and N-terminal pro-B-type natriuretic peptide (NT-proBNP) was collected to conduct eligible cohort study for assessing their effects on APE prognosis. Quality assessment and data extraction were performed in those clinical trials in line with the inclusion criteria. Then, RevMan 5.0 software was applied to carry out meta-analyses. Results Sixteen relevant studies with 1 126 APE patients were included. Nine studies reported BNP level and seven studies reported NT-pro BNP level. There was less satistical and clinical Heterogeneity among the groups (P=0.94, I2=0; P=0.99, I2=0). The meta-analyses results showed: the BNP or NT-pro BNP level was closely related with the short-term all-cause mortality. SPE was 0.52, + LR was 1.87, –LR was 0.20, PPV was 0.16, NPV was 0.98, SROC area under the curve was 0.830 5, SE (AUC) = 0.033 5.Conclusion While elevated BNP levels can help to identify APE patients at a higher risk of death, the high negative predictive value of normal BNP levels is more useful for doctors to identify patients with less likelihood of adverse events so as to conduct a selective follow-up.