探讨经胸超声心动图（TTE）及下肢深静脉超声检查在肺血栓栓塞症（PTE）合并冠状动脉粥样硬化性心脏病（CHD）患者中的应用价值。

选取2010年12月至2015年3月在中国医科大学附属第一医院就诊的PTE患者974例，其中合并CHD者119例（12.22%），包括不稳定型心绞痛94例及心肌梗死25例。回顾患者一般情况、栓塞面积、TTE及下肢深静脉超声检查结果。依据是否有左心室收缩或舒张功能不全或瓣膜病分为组1与组2，采用两样本t检验比较2组间TTE参数。计算TTE诊断影像学大面积肺栓塞（MPE）的敏感度与特异度。

（1）行TTE检查PTE患者发现血栓17例（3.43%），主要位于肺动脉内（11例）。合并CHD者发现血栓4例（5.63%），主要位于右心内（3例）。（2）PTE患者下肢深静脉血栓（LEDVT）检出率为52.60%，合并CHD者LEDVT检出率低于整体水平（34.62%），以左侧下肢及小腿部深静脉血栓多见。（3）TTE发现PTE间接征象46例（64.79%），诊断合并CHD患者MPE的敏感度为84.38%，特异度为51.28%。（4）CHD合并左心室收缩或舒张功能不全或瓣膜病者31例，较40例不合并者肺动脉收缩压[（47.90±21.49）mmHg vs（31.18±22.43）mmHg（1 mmHg=0.133 kPa）]及下腔静脉内径[（19.66±4.41）mm vs （16.20±3.46）mm]均增加，差异均有统计学意义（t=3.227、3.598，P均<0.05）。

PTE患者合并CHD的比例较高，超声有助于发现PTE征象，对诊断MPE有较好的敏感度。对于PTE合并左心疾病患者，超声有助于提示PTE存在的可能。

To discuss the application value of transthoracic echocardiography (TTE) and lower extremity deep venous ultrasonography in patients of pulmonary thromboembolism (PTE) combined with coronary heart disease (CHD).

Nine hundred and seventy-four hospitalized patients of PTE in the first hospital of China medical university between December 2010 and March 2015 was enrolled, 119 cases of these were combined with CHD (12.22%), including 94 cases of unstable angina and 25 cases of myocardial infarction. To review the general information, embolism area and ultrasonic report of the patients of PTE combined with CHD. The patients were divided into two groups according to whether they were combined with left ventricular systolic or diastolic dysfunction or valvular diseases. To compare TTE parameters between the two groups with two-sample t-test and calculate the sensitivity and specificity of diagnosing imaging massive pulmonary embolism (MPE) by TTE.

(1) Seventeen cases thrombosis (3.43%) were observed in PTE patients who underwent TTE. The majority were pulmonary artery thrombosis (11 cases). Four cases of thrombosis (5.63%) were observed in PTE patients combined with CHD. The majority were right heart embolus (3 cases). (2) Lower extremity deep venous thrombosis (LEDVT) was observed in 52.60% of all the PTE patients and 34.62% of PTE patients combined with CHD. The majority were on the left and the deep venous thrombosis of the calf. (3) Fouty-six cases (64.79%) were PTE indirect signs in TTE. The sensitivity of echocardiography diagnosis of MPE was 84.38% and the specificity was 52.60%. (4) Pulmonary arterial systolic pressure [(47.90±21.49) mmHg vs (31.18±22.43) mmHg (1 mmHg=0.133 kPa), t=3.227, P<0.05] and inferior caval vein diameter [(19.66±4.41) mm vs (16.20±3.46) mm, t=3.598, P<0.05] in CHD combined with left ventricular systolic or diastolic dysfunction or valvular heart disease were higher than the control group. The differences were statistically significant.

The proportion of CHD in hospitalized PTE patients was high. TTE could find PTE signs and had high sensitivity for diagnosis of MPE. TTE could prompt the possibility of PTE combined with left heart disease.