The Evaluation Of Therapeutic Effects On Pulmonary Embolism By Typing And Analysing Of Ultrasonic Cardiogram For The Right Ventricular Function

Objectives: Pulmonary embolism(PE) is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream(embolism). It is rather commonly occurred in clinic. Symptoms of PE are represented in complicated and various forms: for the less serious cases, representing no symptom or just short term difficulty breathing; for the severe cases, representing cardiogenic shock, ventricular fibrillation or sudden death. Annual number of the patients suffering from PE is around 300,000 to 600,000, of which about 100,000 to 200,000, died,makes the case fatality rate up to 30%. In the west, PE ranks the third in the race of case fatality rate, after cancer and coronary heart disease. Based on the literature review, the case fatality rate of untreated PE patients may even reach to 90%, while proper and timely treatment being able to lower the case fatality rate to 10%. Obviously it is critical for doctors to recognize the high risk patients precisely and adopt the proper and timely treatment to the patients. Now scholars and experts worldwide have established various clinic evaluation systems from different perspectives, being applied into the risk stratification and the treatment of PE. On the treatment of sub-size block PE with right ventricular dysfunction, however, the debates still exit in clinic. Due to the unique anatomical features(dissymmetry and irregular) of ventriculus dexter, to obtain much more accurate and universal evaluation of right ventricular function, real-time three-dimensional echocardiography, Doppler and tissue Doppler imaging are supposed to be applied into the evaluation together. It can not only assist doctors to exclude some cardiovascular diseases, such as acute myocardial infarction, dissection of aorta, cardiac tamponade, and ventricular septal rupture and so on, but also supply important data and references for the risk stratification of PE, and further for the selection of individual-based treatment plan and the evaluation of curative effect based on the evaluation of right ventricular function. The aim of this thesis is to study on the variations of PE patients’ right ventricular function based on ultrasonic cardiogram, classifying the risk level of PE patients, offering new evaluation index for clinic therapeutic effect of PE and clinic guidelines for the PE treatment and prognosis.Method: referring to ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008, together with the observation of the comparison of ultrasonic cardiogram before and after treatment of PE patients for years, 120 PE patients in the same period were recruited as subjects, of which, 60 as control group, the rest as experimental group. The patients of each group have been divided into three sub-groups: unserious group, mediate group and severe group, based on the index obtained by tests of real-time three-dimensional echocardiography, Doppler and tissue Doppler imaging. In Experimental group, the unserious group receiving anticoagulant therapy and low molecular heparin therapy, 0.2ml/kg subcutaneous injection of two times a day; the mediate group receiving anticoagulant therapy and low molecular heparin therapy, 0.2ml/kg intravenous drip; the severe group receiving thrombolytic therapy and urokinase therapy, 10000U/kg intravenous drip. In Control group, the unserious group receiving anticoagulant therapy and low molecular heparin therapy, 0.2ml/kg subcutaneous injection of once a day; the mediate group receiving anticoagulant therapy and low molecular heparin therapy, 0.1ml/kg intravenous drip; the severe group receiving r-TPA therapy.The following data of all of the patients were collected:1 The technical measurement indexes of Real-time Three-dimensional Echocardiography(RT-3DE) include Right Ventricular End Diastolic Volume(RVEDV) and Right Ventricular Ejection Fraction(RVEF);2 The measurement indexes of Doppler Ultrasonography include Tricuspid Regurgitation Pressure Gap(TRPG), the early peak of forward diastolic flow velocity of tricuspid valve(Em);3 Tissue Doppler Imaging(TDI) is applied into testing the early peak of ring myocardium movement diastolic flow velocity of tricuspid valve(E’m), then calculating the ratio of Em/ E’m.Results:1 The d value variation of treatment indexes of the patients in unserious group(RVEDV, RVEF, PASP and Em/ E’m) of experimental group is better than the cases in unserious group(RVEDV, RVEF, PASP and Em/ E’m) of control group compared before and after treatment. There is significant difference between than(P<0.05).2 The d value variation of treatment indexes of the patients in mediate group(RVEDV, RVEF, PASP and Em/ E’m) of experimental group is better than the cases in mediate group(RVEDV, RVEF, PASP and Em/ E’m) of control group compared before and after treatment. There is significant difference between than(P<0.05).3 The d value variation of treatment indexes of the patients in severe group(RVEDV, RVEF, PASP and Em/ E’m) of experimental group is better than the cases in severe group(RVEDV, RVEF, PASP and Em/ E’m) of control group compared before and after treatment. There is significant difference between than(P<0.05).Conclusions:1 The united application of real-time three-dimensional echocardiography, Doppler and tissue Doppler imaging can accurately and universally evaluate the right ventricular function.2 The united application of real-time three-dimensional echocardiography, Doppler and tissue Doppler imaging may play guiding role for the typing of right ventricular function, the selection of individual-based treatment plan and the evaluation of therapeutic effect.