| Object:To study the value of commonly used diagnostic methods in early diagnosis of pulmonary embolism,and the meaning of the rational treatment and the prognosis evaluation of pulmonary embolism,in order to improve the early diagnostic rate and reduce the rate of missed diagnosis and misdiagnosis rate and mortality of pulmonary embolism.Methods:We retrospectively analysed the clinical history data of 476 patients who were suspected diagnosed of pulmonary embolism from January 2008 to December 2016 in our hospital,and detailed analysed the relevant auxiliary examination information of 406 patients who were definitely diagnosed of pulmonary embolism.The content includes laboratory examination(D-dimer detection,arterial blood gas analysis)and electrocardiograph and imaging examination(UCG,the arms veins colour to exceed,X-ray chest radiograph,64 row CT chest scan,V/Q,pulmonary perfusion SPECT,64-MSCTPA).We divide 476 patients who were suspected diagnosed of pulmonary embolism into three groups,according to the different inspection methods.They are group A(64-MSCTPA)and group B(V/Q)and group C(pulmonary perfusion SPECT).We analyse the sensitivity,specificity,positive predictive value,negative predictive value of the diagnostic methods of pulmonary embolism of the three groups above.Results:In 406 patients with pulmonary embolism,370(91.13%)patients whose D-dimer testing results is larger than 500 ug/L,the highest to 6818 ug/L.In 406 patients,333 cases were checked on arterial blood gas,in which 232 cases(69.67%)were found hyoxemia and 291 cases(65.77%)were found hypocapnia.In 406 patients,only 49 cases(12.07%)whose ECG had typical SIQIIITIII performance.In 369 of 406 patients with UCG,20 cases(5.42%)were found pulmonary artery thrombosis,7 cases(1.90%)were found right atrial thrombus.In 406 patients who were checked on lower limb venous color doppler ultrasound,296 cases(72.91%)were found deep venous thrombosis.In 406 patients with pulmonary embolism,321 cases were checked on the X-ray chest radiograph,in which 16 cases(4.98%)with cusp point hilus pulmonis,bottom toward the pleura wedge shadow.In 406 patients,292 cases were checked on the 64 row CT chest scan(including 69 patients whose the X-ray check normal),among 256(87.67%)who were abnormal,41 cases(14.04%)were found cusp pointing to the hilus pulmonis,triangular bottom toward the pleura,rounded or cuneate high density shadow.In 476 patients who were suspected diagnosed of pulmonary embolism,134 cases were checked on V/Q in which 105 cases were positive.And the sensitivity of V/Q of pulmonary embolism was 88.98%,the specificity was 62.50%,the positive predictive value was 94.59%,the negative predictive value was 43.48%.In 476 patients,163 patients were checked on pulmonary perfusion SPECT,the results of 131 cases were positive.And the sensitivity of perfusion SPECT of pulmonary embolism was 95.62%,the specificity was 92.31%,the positive predictive value was 98.50%,the negative predictive value was 80.00%.In 176 cases who were checked on 64-MSCTPA,the results of 170 patients were positive.And the sensitivity of 64-MSCTPA of pulmonary embolism was 99.42%,the specificity was 87.50%,the positive predictive value was 99.42%,the negative predictive value was 87.50%.Among 170 cases whose 64-MSCTPA results were positive,there are 876 pulmonary embolus,including 568 embolus which locate in the lung segment and lung segment above and 308 embolus which locate in the subsegment pulmonary artery or level 5-6 pulmonary artery,in which the minimum artery diameter is 1 mm.In 170 cases,the filling defect account for 111 cases,523(59.70%),attached to the wall filling defect account for 72 cases,228(26.03%),tramline sign account for 40(4.57%);Totally occluded account for 98(11.19%).Conclusion:1.Because the specificity of laboratory examination such as D-dimer and arterial blood gas analysis of pulmonary embolism is low,so laboratory examination only can be the reference index,eliminate index and curative effect evaluation index of pulmonary embolism;D-dimer can be the emergency screening index of acute pulmonary embolism.2.Echocardiography has high value for the diagnosis of the heart cavity and pulmonary artery trunk thrombosis.X-ray chest radiograph and 64 row CT chest scan can not be the independent diagnosis methods of pulmonary embolism for their low specificity.3.Lung ventilation/ perfusion can be used as an independent diagnosis method of pulmonary embolism for its high sensitivity of pulmonary embolism and pulmonary segments.The examination is more applicable for the patients who are allergic to contrast agents and the patients with renal failure.4.The sensitivity,specificity,positive predictive value and negative predictive value of 64-MSCTPA for pulmonary embolism are high(99.42%?87.50%?99.42%?87.50%),so it can be used as the important independent clinical diagnosis method of pulmonary embolism.It is also noninvasive and can identificate of new and old thrombus.5.The sensitivity and specificity of pulmonary perfusion SPECT and 64-MSCTPA for pulmonary embolism are similar.And pulmonary perfusion SPECT can also makes up for the inadequacy of 64-MSCTPA,because it can also be use on the patients who are allergic to contrast agents and the patients with renal failure. |
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