肺心病患者心电图的变化与肺动脉压的关系

Association between pulmonary arterial pressure and electrocardiogram in cor pulmonale

目的:探讨肺心病患者心电图表现与肺动脉压力的关系。方法:对肺心病103例,慢性阻塞性肺疾病(COPD)30例,进行心电图与血流动力学检查。按心电图表现分为4组,A组19例,B组28例,C组31例,D组25例,COPD为对照组30例。观察各组心电图改变与肺动脉压力的关系。并对各组患者随访5年,对所存活患者,重复首诊的各项检查。结果:①各组患者肺动脉平均压(mPAP),A组22.1土1.6 mmHg,B组23.8土2.7 mmHg,C组31.4土9.1 mmHg,D组45.9土9.2 mmHg,对照组14.5土2.4 mmHg(1 mmHg=0.1333 kPa)。②103例肺心病5年死亡56例(54.4%),其中D组5年死亡25例(100%)。5年存活47例,其中23例mPAP上升≥5 mmHg者,其心电图变化亦较前加重。③P波振幅与右心房平均压(mRAP)、mPAP相关性差(r=0.13、r=0.15)。结论:①胸前导联呈QS波形、右侧胸前导联呈高大R波等,其mPAP多在30 mmHg以上,且预后差。②单独P波振幅≥0.22 mV特异性差。③心电图动态观察时,图形变坏常伴有肺动脉压力的升高。

AIM： To explore the association between pulmonary arterial pressure and ECG in cor pulmonale. METHODS： ECG and hemodynamics were observed simultaneously in 133 patients （ 103 with cor pulmonale, 30 with COPD ）. According to the ECG, patients with cor pulmonale were divided into 4 groups： groupA（n=19）, group B （n=28）, group C （n=31）, group D （n=25）. COPD patients were in the control （ n = 30） . A 5-year follow - up was conducted in all patients. RESULT ： （1）The mean mPAP was 22.1 ± 1.6 mmHg in group A, 23.8 ±2.7 mmHg in group B, 31.4 ±9.1 mmHg in group C, 45.9 ±9.2 mmHg in group D and 14.5 ±2.4 mmHg in control group. （2）Among the 103 patients with cor pulmonale 56 （54%） died within five years, 25（100% ） from D group. In 47 survivors, mPAP elevated ≥5 mmHg in 20 patients with more severe ECG changes. （3） P wave amplitude was poorly correlated with either mean right artrium pressure （ mRAP ） （ r = 0. 13 ） or mPAP （ r = 0. 15 ）. CONCLUSION： （1） QS and tall R wave amplitude in ECG, accompanied with mPAP 〉 30 mmHg indicate a bad prognosis. （2） Single P wave amplitudes〉0.22 mV is not a reliable index. （3） In dynamic observation the worsening on ECG wave often an reflects increase of pulmonary artery pressure .