心电图在急性肺动脉干及左右主肺动脉栓塞早期诊断中的价值

The early diagnosis value of electrocardiographic characteristics in acute embolism in the pulmonary trunk and the main pulmonary arteries

目的探讨不同部位急性肺栓塞（pulmonary embolism，PE）心电图的异常特点及其早期诊断的价值。方法入选郑州大学第一附属医院行64层肺动脉CT血管成像（CT angiography，CTA）检查确诊PE的住院患者147例，根据栓塞部位分为肺动脉干／左右主肺动脉（main pulmonary artery，MPA）栓塞组（A组）和叶肺动脉和（或）远端分支栓塞组（B组），采集完善心电图、D-二聚体、BNP及cTnT等检查，统计心电图异常情况，比较不同部位PE与心电图异常数目及右心室肥大（right ventrieular hypertrophy，RVH）心电图的关系。结果两组症状（呼吸困难、晕厥发生率）、住院病死率及临床指标cTnT、BNP比较，差异有统计学意义（P〈0．05）。A组与B组心电图比较，sIQⅢTⅢ，右束支阻滞（Rightbundle branchb lock，RBBB），V1-V3／V6导联T波倒置（negative Twaves，NTW），Ⅲ、aVF导联ST段压低（ST—segment depression，STD），aVR导联ST段抬高（ST—segment elevation，STE），Ⅲ、aVF导联NTw，V1-V3／V6STD，V1-V3导联STE合并V4-V6导联STD的发生率差异有统计学意义（P〈0．05）。心电图诊断RVH的比例两组差异有统计学意义。相关分析表明A组与心电图异常数目显著相关（r=0．782，t=-7．086，P〈0．05）。结论急性PE发生在肺动脉干以及左右MPA的患者，心电图出现异常的种类增多，RVH也更严重；早期识别心电图异常对诊断急性肺动脉干以及左右MPA栓塞的价值更大。

Objective To investigate the abnormal characteristics of electrocardiogram and its early diagnostic value in acute pulmonary embolism （PE） of different positions. Methods A total of 147 hospitalized patients of acute PE diagnosed by the pulmonary artery CT angiography （CTA） were enrolled in this study and divided into the following two groups： pulmonary trunk or main pulmonary artery （MPA） embolism （group A） and lobar artery or remote branch embolism （group B） . ECG, D-dimer, BNP, cTnT were collected and determined, the varieties of abnormal ECG were counted. Then, the relationships between the severities of the PEs at different positions and the corresponding ECG abnormalities as well as the degree of right ventricular hypertrophy （RVH） were analyzed. Results There were significant differences in dyspnea, syncope, in-hospital mortality and the level of cTnT, BNP between the two groups （ P 〈 0.05 ） . There were significant differences in the occurrence of SIQ Ⅲ TⅢ, right bundle branch block （ RBBB）, ST segment depression （STD） in leads Ⅲand aVF, ST segment elevation （STE） in lead aVR, negative T waves （NTWs） in leads Ⅲ and aVF, STD in leads V1-V3/V6, and STE in leads V1-V3 in combination with STD in leads V4-V6 between the two groups （ P 〈 0. 05 ） . The proportion of RVH diagnosed via ECG has significantly different between the two groups. The result of correlation analysis showed that the incidence of pulmonary trunk or MPA embolism was significantly related to the number of ECG abnormalities （r = 0. 782, t = - 7. 086, P 〈 0. 05 ） . Conclusions The number of abnormal ECGs increase and the RVH is more serious when PE occurring in pulmonary trunk as well as in the MPA, early recognition of electrocardiographic abnormalities is of greater value in the diagnosis of acute pulmonary trunk and MPA embolism.