Wells评分联合心电图及心肌酶谱检测在肺血栓栓塞症诊断中的价值

Application of Wells scale,electrocardiogram and myocardial zymogram in the diagnosis of pulmonary thromboembolism

目的探讨肺栓塞临床预测评分联合心电图及心肌酶谱检测在肺血栓栓塞症诊断中的价值.方法将112例可疑肺血栓栓塞症患者中经螺旋CT肺动脉造影明确诊断的61例患者设为观察组(行常规治疗),其余51例患者设为对照组.对入组患者采用肺栓塞临床预测评分进行肺血栓栓塞症可能性评估,并测定血清α-羟基丁酸脱氢酶、天门冬氨酸氨基转移酶、乳酸脱氢酶、肌酸激酶同工酶及肌酸激酶水平;于治疗前后,对肺血栓栓塞症患者进行心电图检测.结果肺栓塞临床预测评分预测结果显示:高可能性阳性预测值为63.33%(19/30),低可能性阴性预测值为88.00%(22/25).观察组血清α-羟基丁酸脱氢酶、天门冬氨酸氨基转移酶、乳酸脱氢酶、肌酸激酶同工酶及肌酸激酶水平均显著高于对照组(P<0.01).大面积肺血栓栓塞症患者血清α-羟基丁酸脱氢酶及天门冬氨酸氨基转移酶水平显著高于非大面积栓塞患者(P<0.05).治疗后肺血栓栓塞症患者出现心电图动态变化57例(93.44%),其中窦性心动过速、S1 QmTm、QmTm、Tv1-v3发生率较治疗前显著降低(P<0.01).结论肺栓塞临床预测评分对排除肺血栓栓塞症诊断具有一定的价值;血清心肌酶谱检测中肌酸激酶同工酶及肌酸激酶水平对肺血栓栓塞症诊断具有较高的敏感性,可作为肺血栓栓塞症继发心肌损害的诊断指标;肺血栓栓塞症患者治疗后心电图会发生复杂多样的变化.肺栓塞临床预测评分联合心电图及心肌酶检测可提高肺血栓栓塞症的临床诊断准确率.

Objective To explore the value of Wells scale,electrocardiogram and myocardial zymogram in the diagnosis of pulmonary thromboembolism.Methods A total of 112 suspicious PTE patients were enrolled.Among them,61 patients with pulmonary thromboembolism diagnosed by spiral CT pulmonary angiography were set as patient group(routine treatment),the remaining 51 patients were set as the control group.The possibility of clinical PTE was evaluated for all patients using the Wells scale.The levels of serum α-HBH,AST,LDH,CK-MB and CPK were measured.Before and after treatment,electrocardiogram was performed on patients with pulmonary thromboembolism.Results According to the Wells scale,the high probability positive predictive value was 63.33%(19/30),and the low probability negative predictive value was 88.00%(22/25).The levels of serum α-HBH,AST,LDH,CK-MB and CPK in the patient group were significantly higher than those in the control group(P<0.01).Serum α-HBH and AST levels were significantly higher in patients with large-area embolized pulmonary thromboembolism than in non-large-area embolization patients(P<0.05).There were 57 patients(93.44%)with electrocardiogram dynamic changes in PTE patients.Patients with sinus tachycardia,S1QmTm,QmTm,and Tv1-v3 were significantly reduced compared with those before treatment,and the difference was statistically significant(P<0.01).Conclusions The Wells scale has certain value in the diagnosis of FIE;serum CK,CK-MB and other indexes in the detection of serum myocardial enzymes have higher sensitivity to PTE diagnosis and can be used as diagnostic indicators of PTE secondary myocardial damage.The electrocardiogram of patients with thromboembolism may undergo complex and varied changes.Combined with the detection of ultrasound electrocardiogram,the clinical diagnostic accuracy of PTE can be improved.