20例犬急性肺栓塞模型的心电图改变及意义

Electrocardiographic abnormality in the diagnosis of pulmonary embolism:an experimental study

目的分析20例犬急性肺栓塞（PE）模型溶栓前后心电图改变及意义。方法建立20例犬急性PE动物模型后,在急性期及溶栓后行12导联常规心电图检查,分析其心电图表现。结果 20例急性期中,窦性心动过速20例（占100%）;V1导联T波倒置18例（占90%）;V1～V2导联T波倒置17例（占85%）;心房颤动伴心室率〉100次/分13例（占65%）;SⅠ〉0.1mV 11例（占55%）;TⅢ倒置9例（占45%）;QⅢTⅢ8例（占40%）;SⅠQⅢTⅢ5例（占25%）;高度顺钟向转位3例（占15%）;V1～V4导联T波倒置3例（占15%）;电轴右偏（〉＋90°）3例（占15%）;不完全性或完全性右束支阻滞（RBBB）2例（占10%）;V1～V5导联T波倒置2例（占10%）;V1～V6导联T波倒置1例（占5%）;肺型P波1例（占5%）。溶栓后20例中,窦性心动过速或心房颤动伴心室率〉100次/分消失28例（占85%）;胸导联T波倒置加深或由直立变为倒置18例（占90%）;SⅠ变浅或消失10例（占50%）;QⅢTⅢ消失8例（占40%）;TⅢ倒置消失7例（占30%）;SⅠQⅢTⅢ消失5例（占25%）;高度顺钟向转位消失3例（占15%）;不完全性或完全性RBBB消失2例（占10%）;电轴右偏（〉＋90°）消失2例（占10%）;肺型P波消失1例（占5%）。结论急性PE心电图表现是非特异性、非诊断性和有价值的,正确应用有助于急性PE诊断。

Objective To determine the value of electrocardiographic abnormality in the diagnosis of acute pulmonary embolism.Methods Experimental pulmonary embolism was produced in dogs by infusing clots from left jugular vein,and this was confirmed by pulmonary arteriographic findings.Then,all models underwent thrombolysis therapy to remove pulmonary embolism.The serial electrocardiographic changes in 12-lead electrocardiogram were recorded to analyze.Results The models with pulmonary embolism were successfully established in twenty dogs and all had subjected with pulmonary artery recanalization therapy.The serial ECG showed negative T waves in 18 cases,sinus tachycardia in all,atrial fibrillation in 13,SⅠ〉 0.1mV of 11 cases（55%）,TⅢ negative of 9 cases（45%）,QⅢTⅢ of 8 cases（40%）,SⅠQⅢTⅢ of 5 cases（25%）,The clock to turn a height of 3 cases（15%）,Negative T of V1～V4 of 3 cases（15%）,Right aixs dispiacement（ 〉90°） of 3 cases（15%）,Incomplete right bundle branch block or completeness right bundle branch block of 2 cases（10%）,Negative T of V1～V5 are 3 cases（10%）,Negative T of V1～V6 is 1 case（5%）,Pulmonary type of P wave only 1 case 5%.After thrombolytic 20 ECGs,sinus tachycardia or Atrial fibrillation with ventricular rate 〉100bpm disapper of 28 cases（85%）,Negative T of chest limbs disapper of 18 cases（90%）,SⅠ disapper of 10 cases（50%）,QⅢTⅢ disapper of 8 cases（40%）,TⅢ disapper of 7 cases（30%）,SⅠQⅢTⅢ disapper of 5 cases（25%）,The clock to turn a height disapper of 3 cases（15%）,Right aixs dispiacement（〉 90°） disapper of 3 cases（15%）,Incomplete right bundle branch block or completeness right bundle branch block disapper of 2 cases（10%）,Pulmonary type of P wave disapper of 1 case（5%）.and SⅠQⅢTⅢ in 8（baseline vs.recanalization： P〈0.05）.Conclusion Exception of S1QⅢTⅢ changes,most alterations over time were not statistically significant and may be unspecific and not useful in the diagnosis of pulmonary embolism.