自发性气胸与心电图变化的机制研究

Study on the characteristics of electrocardiogram in spontaneous pneumothorax and its mechanism

目的研究自发性气胸导致心电图变化的特点及机制。方法对78例自发性气胸患者用12导心电图自动分析仪描记心电图,测量各导联QRS波群振幅大小变化并测量血清中肌钙蛋白及心肌酶谱,进行统计学分析。结果左侧气胸组QRS波群振幅V1最大,并从V2-V6逐渐减小。左侧气胸组V1及SV1振幅与气胸量呈直线相关,右侧气胸各导联振幅与气胸量无相关性。两组肌钙蛋白及心肌酶谱均在正常范围,并且与气胸量无相关性。结论左侧气胸使心脏与胸壁之间的空气阻碍了左侧胸导联的心电活动向体表的传导,V1及SV1振幅与气胸量呈直线相关是左侧气胸最重要的特征性心电图改变。右侧气胸无此变化。血清中肌钙蛋白及心肌酶谱可排除心电图误诊心肌梗死的可能。

Objective To investigate the characteristics of electrocardiogram of spontaneous pneumothorax and its mechanisms.Methods Electrocardiograms of 78 cases of spontaneous pneumothorax were recorded by 12-lead automatic electrocardiogram.The amplitude of QRS in each lead was recorded,and the serum levels of troponin and myocardial zymogram were detected.Results In left-side pneumothorax patients,the amplitude of QRS was the highest in V1 and decreased from V2 to V6.The amplitudes of QRS in V1,SV1 were linearly correlated with the capacity of pneumothrax.In right-side pneunothrax patients,the amplitude in each lead was not correlated with the capacity of pneumothrax.The levels of troponin and myocardial zymogram were normal and they were not correlated with the capacity of pneumothrax.Conclusion In left-side pneumothrax,the air blocks the transduction of the electro-myocardial variability to the body surface.The linear correlation of the amplitudes of V1 and SV1 with the capacity of pneumothrax is the specific characteristic of the electrocardiogram of left-side pneumothrax,but not right-side pneumothrax.The normal levels of troponin and myocardial zymogram in serum can be used to avoid of the misdiagnosis as myocardial infarction.