急性肺动脉栓塞心电图多指标关联时变模式研究

Study of a Model of Time-Related Multi-Parameters of Electrocardiogam of Acute Pulmonary Embolism

目的:研究急性肺动脉栓塞(APE)的临床心电图动态演化规律,阐明其多样性表现的机制。方法:收集42个APE病例的心电图系列,每一例按记录时间顺序对7个特征性指标(心率,SⅠ、QⅢ、TⅢ、TV1,、STV、RV1或r'V1波)采样。分析该7个特征指标的时变特征,并总结归纳出APE心电图的多指标关联时变模式。结果:该时变理论模式表明,典型APE患者心电图随病程的动态变化,以TV1波倒置达峰时间为界,可化分为3个阶段。发病至TV1波倒置达峰前为第一阶段,TV1波倒置逐渐加深,表现为下降线,其它各指标在该阶段即已迅速完成上升或下降的演变而进入快速回复期,其时变模式曲线呈"反S"型或"S"型;第二阶段即为TV1波倒置达峰阶段,其时间大概处于TVI波总演变时间的前1/3处;自TVI波倒置达峰后至回复发病前水平为第三阶段。结论:临床APE心电图表现之多样性,是不同阶段各指标的联合表现特征和形式多样性的反映。该时变模式曲线可应用于临床判断疾病阶段。

Objective: The purpose of this study was to elucidate the regulation and mechanism of dynamic evolvement of electrocardiogram (ECG) of acute pulmonary embolism (APE). Methods: Fourty-two series of ECG from hospitalized patients with APE were collected. Each ECG series was arranged on time sequence. We analyzed the properties of electrocardiographic changes of 7 parameters ( heart rate, TV1 wave, SI wave.QⅢ wave, ST segment in precordial leads, T'V1 wave and RVt wave). A model of time-related multi-parameters of ECG was set up for APE. Results: The theoretical model showed that the dynamic changes of ECG patterns during evolvement of the disease of typical APE were divided into three phases according to the model curve of Tv1 . The descending limb of the Tv1 curve from the disease onset to the maximum amplitude of inverted TV1 was the first phase characterized by increasing amplitude of inverted TV1 wave, during which the other parameters from their maximum amplitudes rapidly restored (with approximate 'S' or converse 'S' configuration model curves). The peak amplitude on Tv1 curve was defined as the second phase, which occurred at the point of initial one third of the total evolutionary time of Tv1. The ascending limb of Tv1 curve represented the third phase, during which Tv1 gradually restored. Conclusions: The varying manifestations of ECG was due to the different electrocardiographic features influenced by time-related multi-parameters in different stages of APE. This model can be used to determine the stage of APE and improve the accuracy of diagnosis of APE.