心电图与超声心动图诊断急性肺栓塞

The clinical significance of Electrocardiogram and echocardiography in the diagnosis of acute pulmonary embolism

目的探讨心电图与超声心动图在诊断急性肺栓塞中的应用及临床意义。方法对近年来我院收治的68例经心电图检查高度怀疑急性肺栓塞患者行经胸超声心动图和肺动脉造影检查,并对检查结果进行分析。结果心电图示：典型的SⅠQⅢTⅢ型27例,V1、V2导联T波倒置48例,V1-V3导联T波倒置59例,V1、V2导联ST段抬高〈0.1mV者19例,V1、V2导联ST段抬高0.1-0.2mV者12例,IRBBB45例,肺型P波27例,心房颤动4例,窦速63例。超声心动图示：肺动脉分叉处血栓2例,30例典型右心增大并中度以上肺动脉高压;28例未见明显右心系统形态改变但出现轻度肺动脉高压;典型肺动脉栓塞改变32例。肺动脉造影显示：双侧肺动脉栓塞38例,右肺动脉栓塞11例,右下肺动脉栓塞10例,左侧肺动脉栓塞9例。结论心电图对急性肺栓塞的诊断和判断严重程度及预后虽然作用有限,但紧密结合病情及肺动脉造影和超声心动图检查,可减小肺栓塞心电图误诊几率。

Objective Application and clinical significance of ECG and echocardiography in the diagnosis of acute pulmonary embolism. Methods In recent years, our hospital on 68 patients with ECG in patients highly suspected acute pulmonary embolism transthoracic echocardiography and pulmonary angiography, And to analyze the results. Results ECGshowed：TypicalSⅠQⅢTⅢ27cases,V1,V2ECGTwaveinversionin48cases,V1~V3ECGT-wave inversion in 59 cases, V1, V2ST segment elevation 0.1mV 19 cases, lead V1, V2ST-segment elevation 0.1~0.2mV 12cases, IRBBB45 cases, Pulmonary P waves in 27 cases,4 cass of atrial fibrillation, Sinus tachycardia in 28 cases;Echocardiographyshowed： Pulmonaryarterybifurcation thrombosisin 2 cases, 30 casesoftypicalrightheartincreases and moderate pulmonary hypertension, 28 cases no obvious morphological changes of right heart but mild pulmonary hypertension; Pulmonary angiography showed： Bilateral pulmonary embolism in 38 cases, 11 cases of pulmonary embolismand right, rightpulmonaryembolismin 10 cases, 9 casesoftheleftpulmonaryembolism. Conclusions ECG diagnosis of acute pulmonary embolism and determine the severity and prognosis despite a limited role, but in close connection with the disease, and pulmonary angiography and echocardiography, comprehensive analysis,comprehensive judgment, to avoid misunderstanding ECG diagnosis of pulmonary embolism, the clinical diagnostic valuegreater.