aVR导联在急性肺栓塞中的意义

The Effect of Lead aVR in Acute Pulmonary Embolism

目的探讨aVR导联在急性肺栓塞中的意义。方法入选的42名患者,入院就诊时的发病时间为3h^1周,查心肌酶、肌钙蛋白定量等排除急性心肌梗死。根据其临床表现、心电图、超声心动图、肺灌注扫描等确诊为肺动脉栓塞的患者。观察溶栓前(入院时)、溶栓后2周内心电图的动态改变,做超声心动图(是否存在肺动脉高压)、肺灌注扫描(溶栓前后对比),观察疗效及12导联心电图的改变。结果(1)入院时情况:心动过速37例(88.1%),aVRST段抬高26例(61.9%),肺动脉高压39例(92.9%),SⅠQⅢTⅢ13例(31.0%),V1~V3T波倒置23例(54.8%),行肺灌注扫描可见到肺动脉血栓形成42例;(2)溶栓后2周:心动过速3例(7.3%),aVRST段抬高5例(12.2%),SⅠQⅢTⅢ3例(7.3%),V1~V3T波倒置2例(4.9%),肺动脉高压6例(14.6%),肺灌注扫描可见到肺动脉血栓9例(22.0%)。结论心电图改变有些虽然是非特异性的,但其能特异性地反映肺动脉高压的改变,尤其aVR导联,可以观察溶栓效果,心电图对于肺动脉栓塞评价疗效与预后的价值也许更重于诊断价值。

Objective To study the effect of Lead aVR in Acute Pulmonary Embolism, Methods Restrospective analysis of lead aVR in admission, postthrombolysis 1 weeks after treatment was made in 42 patients with Pulmonary Embolism. Results （ 1 ） Tachycardia in 37 cases （ 88.1% ） , evaluation of lead aVR 26 cases （61.9%）, the negative T wave in lead V1 -V3 23 cases （54.8 %）, SⅠQⅢTⅢ in 13 cases （31.0%）, high power in Pulmonary artery 39 cases （92,9%）; （2） Postthrombolysis ： Tachycardia in 3 cases （7.3 % ） , the negative T wave in lead V1 - V3 2 cases （4. 9% ）, SⅠQⅢTⅢ in 3 cases （7.3 % ）, high power in Pulmonary artery 6 cases （ 14.6% ）. Conclusion aVR can observe the effect of thrombolysis. The ecg was important for efficacy and prognostic of Pulmonary Embolism, but more important for diagnosis.