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出 处:《中华全科医师杂志》2005年第2期89-92,共4页Chinese Journal of General Practitioners
摘 要:目的 探讨右胸导联心电图对急性肺栓塞的诊断价值。方法 回顾分析1999年3月至2003年10月收治的98例可疑肺栓塞患者的标准12导联和右胸导联(V3R、V4R和V5R)心电图,对左、右胸导联心电图进行测量和比较。结果 98例中只有23例确诊为急性肺栓塞,其中男18例,女5例,平均年龄(48±10)岁。23例中18例(78% )左、右胸导联均有右心室劳损表现; 13例(72% )的心电图异常改变在入院或症状发作后24h内消失; 9例(39% )同时存在常规12导联心电图异常和右胸导联的ST段抬高; 5例(22% )左胸导联心电图正常,而右胸导联ST段抬高并呈qr、QS型;右胸导联ST段抬高的发生率为56 5% (13 /23); 20例(87% )V3R导联呈qr型。结论 急性肺栓塞时常有右胸导联心电图的特征性改变。当怀疑肺栓塞时,特别是当常规12导联无典型改变时,应描记右胸导联心电图。Objective To identify right-sided chest lead electrocardiograph (ECG) abnormalities in acute pulmonary embolismMethods Changes of routinely recorded 12-lead and right-sided chest leads V 3R, V 4R and V 5R ECGs in 98 patients with suspected pulmonary embolism hospitalized at Ninghe County Hospital during March 1999 to October 2003 were analyzed retrospectively Parameters of both right and left-sided ECGs available were measured and comparedResults Diagnosis of acute pulmonary embolism was established in only 23 (234%) of 98 suspected patients, 18 men (78%) and 5 women (22%), with mean age of (48 ± 10) ECG changes suggestive of acute right ventricular strain were found in both right and left-sided leads in 18 (78%) of 23 patients with pulmonary embolism, and their ECG changes disappeared within 24 hours after admission or onset of symptoms with pulmonary embolism in 13 (72%) of them ST segment elevation in leads V 3R, V 4R, V 5R ,and abnormalities in standard 12-lead ECGs were found in nine (39%), and five (22%) of them with a diagnosis of pulmonary embolism had normal left-sided ECGs, but elevated ST segment and qr or QS pattern (prominent q waves) in leads V 3R, V 4R and V 5R in their right-sided ECGs Thirteen (565%) of them showed ST-segment elevated in leads V 3R, V 4R and V 5R,and 20 (87%) showed qr configuration in lead V 3RConclusions Patients with acute pulmonary embolism often show characteristic ECG changes in right-sided chest leads When pulmonary embolism is suspected, especially no typical changes in routinely-recorded standard 12-lead ECGs can be found, right-sided chest lead ECG should be performed
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