心电图在急性肺动脉栓塞诊断中的价值

Diagnostic value Of ECG in acute pulmonary thromboembolism

目的评估心电图对急性肺动脉栓塞（肺栓塞）的诊断价值。方法回顾性分析43例既往无心肺疾病的急性肺栓塞患者住院首次、溶栓后及出院前系列心电图变化。结果①入院时首次心电图：心动过速26例（60．47％），右束支传导阻滞10例（23．26％）；V1导联和V1～V2导联、V1～V3导联、V1～V4导联、V1～V5导联、V1～V6导联T波倒置分别为34例（79．70％）、20例（46．52％）、12例（27．91％）、9例（20．93％）、7例（16．28％）和2例（4．65％）；SⅠ〉0．1mV、TⅢ倒置、QⅢ和SⅠQⅢTⅢ分别为23例（53．49％）、21例（48．84％）、27例（62．79％）和20例（46．52％）。②溶栓后心电图：心动过速消失20例（76．9％），右束支传导阻滞消失4例（40％），胸前导联T波倒置加深4例，SⅠ变浅、QⅢ减小或消失、TⅢ倒置变浅或直立11例。③出院前心电图：心动过速消失；胸前导联T波直立数增加，ST段回基线，QⅢ进一步减小或消失，TⅢ倒置变浅或直立。结论急性肺栓塞心电图变化多变，需动态观察并密切结合临床加以识别。

Objective To evaluate the diagnostic value of ECG in acute pulmonary thromboembolism. Methods ECG changes on admission, postthrombolysis and predischarge were retrospectively analyzed in 43 patients with acute pulmonary embolism （APE）. Results （1）The ECG changes of acute pulmonary embolism were taehycardia in 26 cases （ 60.47% ） and right bundle branch block in 10 cases （23.26%）. The negative T wave in lead V1, V1 - V2, V1 - V3, V1 - V4, V1 - V5, and V1- V6 were seen in 34 （79.70%） ,20 （46.52%）, 12 （27.91%） ,9 （20.93%）, 7 （ 16.28 % ）, and 2 case （ 4.65 % ）, respectively. S I 〉 0. 1mV were seen in 23 cases （53.49%） ,TⅢ inversion in 21 cases（48.84% ） ,QⅢ pattern in 27 cases（62.79% ） ,S Ⅰ QⅡ TⅢ pattern in 20 cases （46.52） （2）Postthrombolytic ECG changes were： tachycardia disappeared in 20 cases, right bundle branch block disappeared in 4 ease,T wave inversion in V1 -V5 became deeper in 13 cases, S Ⅰ reduced,TⅢ wave inversion shallowed,QⅢ decreased or disappeared in 11 cases;（3）Predischarge ECG changes were ：tachycardia disappeared,the magnitude of negative T wave in V1 - V5 was decreased, ST-segment depression went back to baseline, Q Ⅲ decreased or disappered,TⅢ wave inversion shallowed or disappeared. Conclusion There are various abnormalities on the ECG observed in the patient with pulmonary embolism. It must be noted that pulmonary embolism cannot be precisely diagnosed solely on the basis of ECG changes. It is of great importance to observe the dynamic ECG changes and combined closely with clinical findings.