急性肺动脉栓塞患者溶栓治疗过程中心电图V_1导联T波变化的特点观察

The observation of the character of electrocardiographic T wave changes on V_1 precordial leads of patients with acute pulmonary embolism receiving thrombolytic therapy

目的 观察急性肺动脉栓塞 (APE)患者溶栓前后心电图随时间变化的特征 ,分析溶栓治疗对APE患者心电图的影响及其可能的作用机制。方法 收集 19个溶栓APE病例的心电图系列。分析所有病例V1 导联T波时变曲线的特征。结果 APE溶栓患者心电图V1 导联T波演变表现为两种模式 ,“W型”或“V型”。两种时变曲线的溶栓时刻不同 ,前者位于溶栓前T波演变的上升支 ,而后者则位于T波演变的下降支。但无论哪种类型 ,溶栓均造成T波倒置的进一步加深。结论 溶栓治疗显著影响APE后T波的演变过程 ,溶栓前、后的T波演变 ,可能分别与急性右心室和左心室扩张有关 ,溶栓后出现的倒置T波的加深加宽 ,可以作为溶栓再通判断的心电图特征。

Objective To characterize the electrocardiographic (ECG) T wave changes on precordial leads of patients with acute pulmonary embolism (APE) receiving thrombolytic therapy and to analyse the effect of thrombolytic treatment on ECGs and its possible mechanisms.Methods ECGs of 19 consecutive patients hospitalized for APE and receiving thrombolytic therapy were collected.The properties of T wave changes on precordial leads(represented by T wave on V 1, TV 1)were analyzed and a model of TV 1 changes with time was drawn.Results The theoretical model showed “W” or “V” configuration. The time of thrombolytic treatment was different between the two configurations. The former was located at the ascending branch (reversion stage) of the time-dependent variation curve of inverted TV 1 wave before thrombolysis and the latter was located at the descending branch. Thrombolytic therapy at both configurations increased the extent of inversion of TV 1 wave.Conclusions Thrombolytic therapy significantly affects the evolution of TV 1 wave. The change of TV 1 wave before thrombolysis may be due to the dilatation of right ventricle and the increase in TV 1 inversion after thrombolysis may be attributed to the enlargement of left diastolic volume and can be considered as a marker of thrombolytic success.