心电图评分在老年急性肺血栓栓塞症严重程度评估中的应用

Application of ECG score in risk assessment of old patients with acute pulmonary thromboembolism

目的探讨心电图评分在老年急性肺血栓栓塞（PTE）患者危险评估中的应用价值。方法观察60例急性PTE患者Daniel心电图分值与放射性核素全肺灌注缺损百分数（PLPD）、超声心动图右心室前后径和肺动脉收缩压（SPAP）、动脉血气指标的关系，应用受试者工作特征（ROC）曲线评估心电图分值预测PPDS＞50％和SPAP＞50mmHg的准确度。结果心电图评分值与PLPD和右心室前后径呈正相关；与肺动脉压呈等级正相关；与PaO2呈负相关。心电图分值预测PPDS＞50％的ROC曲线下面积为0.888±0.054，95％CI为0.774-0.985（P＜0.01）；心电图分值预测SPAP＞50mmHg的曲线下面积为0.763±0.093，95％CI为0.581-0.945（P＜0.05），当Daniel 心电图分值为9.5时，其预测 PPDS＞50％的敏感度为76.2％，特异度为84.2％。结论在老年急性PTE危险评估中，心电图评分是一种简便而较可靠的方法。

Objective To determine the value of ECG score in risk assessment of old patients with acute pulmonary thromboembolism （PTE）. Methods Daniel ECG score, the percentage of lung perfusion defect （PLPD）on radionuclide examination, right ventricular diameter and systolic pulmonary artery pressure （SPAP） on echocardiography, and arterial blood gas analysis were obtained in 60 old patients with acute PTE. Receiver operating characteristic curve （ROC） was performed to evaluate accuracy of ECG score in prediction of PLPD 〉50% and SPAP〉50mmHg. Results The ECG score was positively correlated with PLPD and right ventricular diameter, correlated with SPAP by grade and negatively correlated with PaO2. ROC of the ECG score was 0.888 ± 0.054 （95%CI：0.774-0.985, P〈0.01） for predicting PLPD〉50%and 0.763 ± 0.093 （95%CI：0.581-0.945, P〈0.05） for predicting SPAP〉50mmHg. With a cutoff value of 9.5, the sensitivity and specificity of the ECG score for predicting PLPD〉50%were 76.2%and 84.2%,respectively. Conclusion ECG score is a simple and relatively reliable means of risk assessment of old patients with acute PTE.