急性肺栓塞患者心电图表现及对预后的影响分析

The effect of electrocardiogram and prognosis in patients with acute pulmonary embolism

目的分析急性肺栓塞患者心电图表现,并观察心电图变化对患者预后的影响,为预测急性肺栓塞患者病情及转归提供参考依据。方法回顾性分析本院2010年4月至2015年4月收治的437例急性肺栓塞患者的临床资料。按照患者入院30天的预后情况将其分为存活组及病死组,比较两组患者的临床资料和心电图表现的差异,将存在统计学差异的因素纳入Logistic多因素回归分析,并分析心电图表现对患者预后的影响。结果 437例急性肺栓塞患者中,存活388例(88.8%),病死49例(11.2%)。两组中晕厥、休克、心脏病病史、慢性阻塞性肺疾病病史的患者所占比例比较差异均有显著性(P<0.05)。两组中完全性右束支传导阻滞,Ⅰ、Ⅱ、V_(4~6)导联ST段抬高或压低,Ⅲ、aVF导联Q波异常等心电图特征的患者所占比例比较差异均有显著性(P<0.05)。Logistic多因素分析显示,晕厥、休克、心脏病病史、心电图异常均为影响急性肺栓塞患者预后的独立危险因素(P<0.05),其中心电图异常的风险比最高,为12.244;心电图异常患者的病死风险是未合并心电图异常患者的6.841~21.914倍。以心电图是否异常为预测截点,心电图异常预测急性肺栓塞患者病死的接受者操作特征曲线(ROC曲线)下面积为0.646,灵敏度为52.0%,特异度为71.0%。结论多数急性肺栓塞患者均存在心电图异常表现,且随着心电图异常的加剧,其预后呈恶化趋势,结合临床症状、既往病史可进一步提高急性肺栓塞患者预后评估的准确性。

Objective To analyze the manifestation of electrocardiogram（ECG） in patients with acute pulmonary embolism（APE）, and to observe the effects of ECG changes on the prognosis of patients, so as to provide reference for APE patient＇s condition and prognosis. Method 437 patients with APE admitted to our hospital from April 2010 to April were retrospectively analyzed. In accordance with the 30 days prognosis of patients, they were divided into survival group and death group, compared two groups of patients with clinical data, electrocardiogram（ECG） and statistically significant factors included in the multivariate Logistic regression analysis, clear manifestation of ECG effect on the prognosis of patients. Result Of the 437 patients, 388 cases（88.8%） survived, 49 cases（11.2%） died. The proportion of patients with syncope, shock, heart disease, chronic lung disease history between the two groups were significantly different（P〈0.05）. Two groups of patients with complete right bundle branch block, Ⅰ, Ⅱ, Ⅴ_（4 ~ 6） lead ST segment elevation or depression, Ⅲ, Q wave in lead AVF abnormal ECG characteristic, the differences were statistically significant（P〈0.05）. Multi factor analysis showed that the symptoms of syncope, shock, heart disease, ECG abnormalities were independent risk factors affecting the prognosis of the patients with APE. The risk of electrocardiogram abnormalities was the highest（12.244）. The risk of ECG abnormalities was 6.841 ~ 21.914 times higher than that of patients with abnormal electrocardiogram. The area under the receiver operating characteristic curve（ROC curve） was 0.646, with a sensitivity of 52.0% and a specificity of 71.0%, according to the ECG abnormality, and ECG abnormality predicted the acute pulmonary embolism. Conclusion Most of the patients with APE were found abnormal ECG findings and with abnormal ECG increased, the prognosis is deteriorating trend, combined with clinical symptoms, past history, to further improve the accuracy of the evaluation of the prognosis of patients with APE.