The Value Of Cardiovascular Ultrasound In The Diagnosis Of Pulmonary Embolism And The Logistic Regression Model For The Diagnosis Of Pulmonary Embolism

Background:Pulmonary embolism(PE)is a disease characterized by pulmonary circulation and respiratory dysfunction caused by endogenous or exogenous embolism obstructing pulmonary artery or its branches.The disease is one of the main causes of sudden death in clinic.It has a high mortality and disability rate both at home and abroad,and has become an important medical and health problem worldwide.The clinical symptoms of pulmonary embolism are lack of specificity,and only about 20%of the patients suffer from dyspnea,chest pain and hemoptysis at the same time.Therefore,the early diagnosis of pulmonary embolism is very important,and it is a hot and difficult problem in the medical field.At present,the diagnosis of pulmonary embolism mainly depends on CT pulmonary angiography(CTPA),which can diagnose pulmonary embolism above segment,but it has some limitations due to adverse reactions of contrast media and radiation damage.Ultrasound has the characteristics of convenience,rapidity,non-radiation and high repeatability.It is more and more widely used in clinic.Especially in ICU,bedside ultrasound is favored by more and more clinicians.Objective:By observing the characteristics of cardiovascular ultrasound in patients with pulmonary embolism,the diagnostic value of echocardiography combined with peripheral vascular ultrasound in pulmonary embolism above segment was studied,and the clinical detection rate of pulmonary embolism above segment was explored.Through the analysis of the diagnostic data of pulmonary embolism patients,the characteristic index of ultrasound diagnosis of pulmonary embolism was found,and the diagnostic model of pulmonary embolism was established by multivariate logistic regression analysis,which provided the basis for rapid clinical diagnosis and timely treatment of pulmonary embolism.Methods:A retrospective analysis was made of 110 patients suspected of pulmonary embolism in the First Affiliated Hospital of Henan University of Science and Technology from February 2017 to August 2018.Sixty patients in PE(pulmonary embolism)group and 50 patients in non-PE group were finally diagnosed.The ultrasonographic indexes of 60 patients in PE group were analyzed,and the diagnostic value of ultrasonography for pulmonary embolism was studied.The characteristic index of embolism included the ratio of right ventricular end-diastolic diameter to left ventricular end-diastolic diameter(RVED/LVED),right ventricular end-diastolic diameter(RVED),right atrial end-diastolic diameter(RADD),tricuspid regurgitation velocity(TRV),pulmonary artery pressure(SPAP),pulmonary artery diameter(MPAD),abnormal interventricular septal motion,lower extremity venous thrombosis and tricuspid regurgitation.Accumulation,pericardial effusion and right ventricular ejection fraction(RVEF).Multivariate analysis and regression model were established by binary logistic stepwise regression,which entered the model standard P<0.05 and excluded standard p>0.10.The regression effect of the model was tested by likelihood ratio and goodness of fit.ROC curve analysis was used to predict and diagnose pulmonary embolism with different indicators.p<0.05 was used as the criterion for statistical significance.Results:Statistical analysis was made on multiple ultrasound parameters between PE group and non-PE group.1.RVED/LVED,RVED,RADD,TRV,SPAP,MPAD,RVEF,abnormal interventricular septal motion and lower extremity venous thrombosis in PE group were all higher than those in non-PE group(p<0.05).There was no significant difference in the area of tricuspid regurgitation and pericardial effusion between PE group and non-PE group.And pulmonary artery diameter is an independent factor affecting pulmonary embolism.The three factors are positively correlated with the occurrence of pulmonary embolism,that is,the greater the right ventricular diastolic end diameter,the right atrial diastolic end diameter and the pulmonary artery diameter,the greater the risk of pulmonary embolism,which accords with hemodynamic changes.2.By logistic regression analysis,the predictive diagnosis model of pulmonary embolism was established:Logit(P)=-20.496+0.168×(anterior and posterior diastolic diameter of right ventricle)+0.275×(left and right diastolic diameter of right atrium)+0.250×(inner diameter of pulmonary artery).The likelihood ratio test showed that the regression model had statistical significance(?~2=88.503,p<0.001).The goodness-of-fit test showed that the model had a good fit(?~2=14.339,p=0.073).The regression model was diagnosed as pulmonary embolism with p<0.50.The diagnostic accuracy of the regression model was 88.18%,and the area under concentration-time curve(AUC)of ROC curve was 0.950,95%confidence interval.(0.913-0.987),with statistical significance(p<0.001),indicating that the model has significant significance in pulmonary embolism.Conclusion:Systematic,comprehensive and dynamic echocardiography and peripheral vascular ultrasonography are of great value in the diagnosis of pulmonary embolism.By comparing and statistical analysis of several ultrasonographic parameters,the characteristic index of pulmonary embolism diagnosed by ultrasonography was found.It was found that the independent influencing factors of pulmonary embolism include right ventricular end-diastolic diameter,right atrial end-diastolic diameter and pulmonary artery inner diameter.The regression model has a high coincidence rate in the diagnosis of pulmonary embolism and can provide reliable basis for rapid clinical diagnosis and treatment of pulmonary embolism.