高原肺水肿早期心电图和超声心动图改变及其意义探讨

Investigation of changes of electrocardiogram and ultrasonic cardiography of high altitude pulmonary edema in early stage and their clinical significance

目的对高原肺水肿(HAPE)早期心电图与超声心动图改变及其意义进行探讨。方法应用高原症状评分表对急进高原人员进行评分,筛选出高度疑似HAPE者作为重点观察及随访对象,并对全部重点观察及随访对象行心电图与超声心动图检测分析。结果高度疑似HAPE对象中,非HAPE组及HAPE组在早期即出现心电图及超声心动图改变。两组比较,HAPE组窦性心动过速(>100次/min)、电轴右偏、顺钟向转位、不完全性右束支传导阻滞、ST-T改变、P波高尖及肺动脉高压的发生率,在第1d或第2d均显著高于非HAPE组(P<0.01或P<0.05)。结论 HAPE患者早期心动过速、顺钟向转位、P波高尖及肺动脉高压的出现具有重要诊断价值,尤其是早期显著的肺动脉高压的形成,可作为HAPE早期诊断的重要依据。

Objective To explore the changes of electrocardiogram（ECG）and ultrasonic cardiography（UCG）in the early stage of high altitude pulmonary edema（HAPE）and their clinical significance.Methods People who arrived at high altitude rapidly were scored by using high altitude symptoms scale,and then the cases of highly suspected HAPE were singled out as the subjects for intensive observation and follow-up.They received ECG and UCG examination and the results were analyzed.Results ECG and UCG showed obvious changes in both HAPE group and non-HAPE group among above highly suspected HAPE suspects.Compared with non- HAPE group,subjects in HAPE group had more incidence of sinus tachycardia（100 times/min）,right axis deviation,clockwise rotation,incomplete right bundle branch block（IRBBB）,ST-T changes,tall peaked P wave and pulmonary hypertension on day 1 or day 2 after they arrived at high altitude（P0.05 or P0.01）.Conclusion The pyknocardia,clockwise rotation,tall peaked P wave and pulmonary hypertension are greatly valuable to the early diagnosis of HAPE,especially apparent pulmonary hypertension in early stage.