D-二聚体联合心电图检测对急性肺栓塞的诊断意义

Diagnostic significance of combined detection of D-dimer and electrocardiography in acute pulmonary embolism

目的探讨D-二聚体与心电图联合检测对急性肺栓塞(APE)患者的诊断意义,为急性肺栓塞的诊治提供快速、有效的依据,也对基层医院急性肺栓塞患者的救治提供帮助。方法回顾性分析十年来两个社区医院由三甲医院骨科手术术后转来做术后康复及本地区收治的慢性疾病患者,在治疗期间发生肺栓塞12例,均为老年患者,男性5例,女性7例,年龄70-86.7岁,平均年龄为(74.8±5.12)岁,9例患者年龄>72岁。行髋关节置换术7例、膝关节置换术1例、腰椎管狭窄术1例、脑梗死1例、冠心病心力衰竭及风湿性心脏瓣膜置换后心衰各1例。采用D-二聚体联合心电图检测评估其与肺栓塞的相关性。结果12例患者均经肺CT或肺动脉造影证实肺栓塞,均在急性肺栓塞发生前后做D-二聚体、心电图检测。所有患者发生肺栓塞前D-二聚体(2.3±0.9)mg/L,发生肺栓塞后D-二聚体明显升高[(5.97±1.16)mg/L],与发生肺栓塞前比较,有统计学意义(P<0.01)。12例患者发生肺栓塞时心电图与住院时心电图比较变化如下:发生完全性右束支传导阻滞2例,发生不完全性右束支传导阻滞3例,严重心肌缺血4例表现为V1-V4导联T波倒置,aVR导联R波增高3例,心电图没有任何变化3例。9例患者表现窦性心动过速,3例为正常窦性心率。12例患者11例存活,1例死亡。结论D-二聚体与心电图联合检测对急性肺栓塞具有较好的诊断意义。

Objective To explore the diagnostic significance of D-dimer(D-D)and electrocardiography combined detection in patients with acute pulmonaryembolism(APE),to provide rapid and effective basis for the diagnosis and treatment of APE,ang also to provide help for the treatment of patients with APE in primary hospital.Methods In this study,a retrospective study was used to collect data from two Community Health Service Centers from ten yeras,which was diagnosed as pulmonary thromboembs.12 patients with pulmonary embolism were enrolled in this study.12 cases were analyzed,including 5 males and 7 females,age 70 to 86.7 years old,with an average age of(74.8±5.12)years.There were 7 cases of Hip replacement and 1 cases of total knee arthroplasty.Ultrasonic determination was performed on DVT patients complicated with PE.Results All 12 patients were confirmed to have pulmonary embolism by pulmonary CT or pulmonary angiography,and D-dimer and electrocardiogram tests were performed before and after the occurrence of acute pulmonary embolism.All patients had a significant increase in D-dimer(2.3±0.9)mg/L before and after pulmonary embolism(5.97±1.16)mg/L,which was statistically significant(P<0.01)compared to before pulmonary embolism.The electrocardiograms of 12 patients with pulmonary embolism were compared with those in hospital as follows:2 patients with completeness right bundle branch block,3 patients with completeness right bundle branch block,4 patients with severe myocardial ischemia showed inversion of T wave in lead V1-V4,3 patients with increased R wave in lead aVR,and 3 patients with no change in electrocardiograms.Nine patients presented with sinus tachycardia,and three had normal sinus heart rate.Among the 12 patients,11 survived and 1 died.Conclusions The combination of D-dimer and electrocardiography has better diagnostic significance for acute pulmonary embolism.