| Objective The significance of the changes of right heart system function and the distribution of venous thrombosis in lower extremities in patients with pulmonary embolism was discussed in order to improve the diagnosis and treatment of pulmonary embolism and reduce the mortality.Methods A retrospective analysis was performed on 140 patients with pulmonary embolism who were diagnosed and treated by bozhou clinical college of anhui medical university from July 2015 to July 2018.All patients with pulmonary embolism were confirmed by computed tomographic pulmonary angiography(CTPA).After screening according to the inclusion criteria,54 patients in the cardiac color doppler ultrasound group were selected,including 28 males and 26 females.There were 124 cases in the ultrasound group,including 61 cases in male and 63 cases in female.The right ventricular dilatation degree(RVDd/LVDd),right ventricular free wall motion amplitude(RVWM),tricuspid regurgitation velocity(TRV)and tricuspid annular plane systolic excursion(TAPSE)of the cardiac color doppler ultrasound group patients of before and after pulmonary embolism were collected in detail for intergroup statistically analysis.The common femoral vein,deep/superficial femoral vein,popliteal vein,anterior/posterior tibial vein,peroneal vein and great/small saphenous vein thrombosis of the lower extremity venous compression ultrasound group patients of different stratified pulmonary embolism were collected in detail.Then,the number of vascular embolism,embolus diameter,bilateral/unilateral veins,deep/superficial veins and proximal/distal veins were classified and statistically analyzed.Results1.Transthoracic echocardiography revealed that RVDd/LVDd before and after pulmonary embolism were 0.82 ± 0.07,0.95 ± 0.13,RVWM were(9.18 ± 0.70)mm,(7.73 ± 0.33)mm,and TRV were(1.10 ± 0.83)m/s,(3.28 ± 0.36)m/s,and TAPSE were(18.52 ± 0.81)mm,(16.73 ± 0.92)mm,respectively.The differences between the two groups were statistical significance(P <0.05).The values predicting changes in right ventricular system function related to pulmonary embolism were 0.95,7.73 mm,3.28 m/s,and 16.73 mm,respectively.2.Lower extremity venous compression ultrasonography revealed that the number of vascular embolism in the high-risk pulmonary embolism group,in the intermediate-risk pulmonary embolism group,and in the low-risk pulmonary embolism group were(1.64 ± 0.70),(1.22 ± 0.58),and(0.62 ± 0.49),the embolus diameter were(13.41 ± 1.10)mm,(17.72 ± 1.30)mm,and(8.68 ± 1.27)mm,and the bilateral venous positive rates were 52%(13/25),18%(11/60),and 0%(0/39),and the unilateral venous positive rates were 48%(12/25),75%(45/60),and62%(24/39),and the deep venous positive rates were 72%(18/25),65%(39/60)and 56%(22/39),and the superficial venous positive rates were 36%(9/25),30%(18/60)and 5%(2/39),and the proximal venous positive rates were 88%(22/25),55%(33/60),and 23%(9/39),and the distal venous positive rates were 16%(4/25),38%(23/60),and 36%(14/39),respectively.There were statistically significant differences in the number of vascular embolism,embolus diameter,bilateral venous positive rates,superficial venous positive rates,and proximal venous positive rates between the three groups(P <0.05).There was no statistically significant difference in superficial venous positive rates between the high-risk pulmonary embolism group and the intermediate-risk pulmonary embolism group(P> 0.0167),and the difference between the other two groups was statistical significance(P<0.0167).There were statistically significant difference in unilateral venous positive rates between the three groups(P <0.05),with a statistically significant difference between in the high-risk pulmonary embolism group and in the intermediate-risk pulmonary embolism group(P <0.0167),and the difference between the other two groups was no statistical significance(P> 0.0167).There were no significant difference in deep venous positive rates and distal venous positive rates between the three groups(P> 0.05).3.The diameter of lower extremity venous embolus was compared between different stratified pulmonary embolisms.The embolus diameter in the high-risk pulmonary embolism group was(13.41 ± 1.10)mm,and its size was between the low-risk pulmonary embolism and intermediate-risk pulmonary embolism.The differences between the three groups were statistical significance(P <0.05),and the differences between the two groups were statistical significance(P <0.0167).Conclusion1.RVDd/LVDd,RVWM,TRV,and TAPSE are related to changes in right heart function caused by pulmonary embolism.When RVDd/LVDd > 0.95,RVWM < 7.73 mm,TRV > 3.28m/s,and TAPSE< 16.73 mm,the possibility of pulmonary embolism may be suggested and the confirmed examination should be conducted actively.2.The risk stratification of pulmonary embolism varies with the distribution of venous thrombosis in lower extremities.In the high-risk group,the number of vascular embolism was the highest,the embolus diameter was middle,and the positive rates of the bilateral veins and the proximal veins were the highest,indicating that the bilateral proximal lower extremity deep venous thrombosis with large number of vascular embolism and middle embolus diameter is a risk factor for the high-risk pulmonary embolism.The superficial venous positive rates in the high-risk pulmonary embolism group was higher than that in the low-risk pulmonary embolism group,and there was no difference with that in the intermediate-risk pulmonary embolism group,indicating that the lower extremity deep venous thrombosis with superficial venous embolism is a risk factor for the high-risk and intermediate-risk pulmonary embolism.The unilateral venous positive rates in the highrisk pulmonary embolism group was lower than that in the intermediate-risk pulmonary embolism group,and there was no difference with that in the low-risk pulmonary embolism group,indicating that the unilateral lower extremity deep venous thrombosis is a risk factor for the intermediate-risk pulmonary embolism.In view of the above risk factors,we should be more vigilant,identify and diagnose pulmonary embolism with different risk stratification in time,and carry out targeted treatment as soon as possible.3.The shedding of the medium-sized lower extremity venous embolus with a diameter of 13.41 ± 1.10 mm is closely related to the occurrence of high-risk pulmonary embolism. |
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