急性肺栓塞患者溶栓抗凝治疗前后的心电图变化特征研究

Changes of Electrocardiogram of Patients with Acute Pulmonary Embolism before and after Thrombolytic Therapy

目的:研究急性肺栓塞患者溶栓抗凝治疗前后的心电图变化特征。方法:选择2012年1月~2016年12月在我院进行诊治的急性肺栓塞患者80例,所有患者均给予溶栓抗凝治疗(静脉滴注20000 U/kg尿激酶+100 ml 0.9%氯化钠注射液,口服华法林3 mg/次,以及皮下注射低分子肝素0.01 m L/kg)。分别于治疗前后对所有患者行常规12导联同步心电图自动分析仪进行心电图检查,观察80例急性肺栓塞患者溶栓抗凝治疗前后的心电图特征以及心电图变化。结果:经过溶栓抗凝治疗后,80例急性肺栓塞患者的右束支传导阻滞发生率为16.25%(13/80),与治疗前的26.25%(21/80)相比无明显差异(P>0.05);胸前导联T波倒置加深的发生率为37.50%(30/80),明显低于治疗前的48.75%(39/80)(P<0.05);Ra VR>0.06 m V的发生率为3.75%(3/80),明显低于治疗前的25.00%(20/80)(P<0.05);窦性心动过速的发生率为5.00%(4/80),明显低于治疗前的71.25%(57/80)(P<0.05);SⅠQⅢTⅢ的发生率为6.25%(5/80),明显低于治疗前的46.25%(37/80)(P<0.05);肺型P波的发生率为3.75%(3/80),与治疗前的6.25%(5/80)相比无明显差异(P>0.05);顺钟向转位的发生率为6.25%(5/80),明显低于治疗前的41.25%(33/80)(P<0.05)。结论:溶栓抗凝治疗可以显著改善急性肺栓塞患者的心电图指标,心电图在临床急性肺栓塞的诊断中虽然缺乏特异性,但如果可以结合观察患者治疗前后的心电图变化特征,对该病的诊疗具有重要的临床意义。

Objective： To investigate the changes of electrocardiogram of patients with acute pulmonary embolism before and after thrombolytic therapy. Methods： 80 cases of patients with acute pulmonary embolismwho treated in our hospital from January 2012 to De- cember 2016 were selected. All the patients were given thrombolytie therapy （intravenous infusion of 20000 U/kg urokinase ＋100 mL Sodium Chloride Injection, oral warfarin for 3 mg/times, and subcutaneous injection of low molecular weight heparin of 0.01 ml / kg） and underwent conventional 12 lead ECG automatic analyzer, the changes of ECG characteristics before and after thrombolysis of pa- tients with anticoagulation were observed. Results： After thrombolytic therapy, the right bundle branch block incidence rate was 16.25% （13/80）, which showed no significant difference with that before treatment [26.25%（21/80））（P〉0.05）; the incidence rate ofprecordial T wave inversion deepened was 37.50% （30/80）, which was significantly lower than that before treatment[48.75% （39/80）]（P〈0.05）; the in- cidence rate ofRa VR 〉 0.06 mV was 3.75 % （3/80）, which was significantly lower than that before treatment[25.00% （20/80）]（P〈0.05）; the incidence rate of sinus tachycardia was 5.00 % （4/80）, which was significantly lower than that before treatment [71.25%（57/80）]（P〈 0.05）; the incidence rate ofS I QIIITIII was 6.25% （5/80）, which was significantly lower than that before treatment[46.25%（37/80）[（P〈0. 05）; the incidence rate of pulmonary P wave was 3.75% （3/80） which showed no significant difference with that before treatment[6.25% （5/80）]（P〉0.05）; the incidence rate of clockwise rotation was 6.25% （5/80）, which was significantly lower than that before treatment [41.25%（33/80）]（P〈0.05）. Conclusion： Thrombolysis and anticoagulation therapy can significantly improve the ECG indexes in patients with acute pulmonary embolism, although ECG in the diagnosis of acute pulmonary embolism is lack of specificity, but if it can be com- bined with the changes of electrocardiogram characteristics of patients before and after treatment, it has important clinical significance for the diagnosis and treatment of the disease.