心电图对急性大面积肺栓塞的预测价值

Role of the electrocardiogram in evaluating the severity of acute pulmonary embolism

目的探讨急性肺栓塞患者心电图(ECG)改变与肺栓塞严重度的相关性。方法选择2000年12月至2004年11月,所有经肺螺旋CT证实为急性肺栓塞,并且符合入选标准的40例住院患者。评价他们的心电图改变与肺血管成像、血流动力学及血气改变之间的相关性。结果胸前导联T波倒置和SⅠQⅢTⅢ与肺栓塞的严重度具有很强的相关性,随着胸前导联T波倒置范围的左移,肺栓塞的严重程度可能在逐渐加重。肺血管床阻塞面积百分比(POPAB)>49%的大面积肺栓塞患者中,心电图出现胸前导联(V1-2)T波倒置的患者占83%,显著高于非大面积肺栓塞组。通过分析15种急性肺栓塞(APE)常见的ECG改变,结果发现这些ECG改变数目≥5个时或胸前导联T波倒置数目≥3个时,对大面积肺栓塞的筛查更有意义。结论ECG改变对筛查大面积肺栓塞具有重要的临床价值。

Objective The purpose of our study was to examine the relationship between ECG abnormalities and the sevety of acute pulmonary embolism （APE）. Methods Analysis of ECG changes in 40 Chinese patients who were diagnosed with APE by spiral CT angiography was made during 12/2000-11/2004. We sought to evaluate changes in ECG signs compared with angiographie, hemodynamie changes and gas exchanges in pulmonary embolism. Results Among those ECG signs, there were relationships between the frequency of negative T in preeordial lead, S I Q Ⅲ TⅢ and the severity of pulmonary embolism. A shift in the transition zone from V1 to V5 could predict the severity of pulmonary embolism increases. Anterior T wave inversion（83%） in V1-2 were more frequently observed in the massive PE （POPAB〉49%）than in non massive PE significantly . By analyzing 15 specific abnormalities in the ECG, our study shows that the total number of ECG abnormalities and negative T wave positively correlated with the severity of PE. Conclusion These results suggested that anterior T wave inversion were frequently observed in the massive PE which can be used to evaluate the severity of PE. The total number of ECG abnormalities≥ 5 or the total number of negative T≥ 3 can allow the massive forms to be distinguished.