心电图评分在急性肺血栓栓塞症严重程度评估中的应用  

Evaluation of an electrocardiographic score system in predicting the severity of acute pulmonary thromboembolism

作　　者：张蔚[1] 梁瑛[1] 杨京华[1] 宗华[1] 朱光发[1] 

机构地区：[1]首都医科大学附属北京安贞医院呼吸科,100029

出　　处：《临床肺科杂志》2009年第5期580-583,共4页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨心电图(ECG)评分在急性肺血栓栓塞症(PTE)患者危险评估的应用价值。方法观察ECG异常类型及其评分值;评价分值与放射性核素全肺灌注缺损百分数(PPDS)、超声心动图右心室前后径、肺动脉收缩压(SPAP)、动脉血气指标的关系,应用受试者工作特征(ROC)曲线评估ECG分值预测PPDS>50%和SPAP>50 mmHg的准确性。结果40例急性PTE患者的ECG评分值与PPDS和右心室前后径呈正相关;与SPAP呈等级正相关;与PaO2呈负相关。ECG分值预测PPDS>50%和SPAP>50 mmHg准确性的ROC曲线下面积分别为0.888和0.763。ECG分值>9.5时预测PPDS>50%的敏感性和特异性分别为76.2%和84.2%;ECG分值>11.5时预测SPAP>50 mmHg的敏感性和特异性分别为70.0%和73.9%。结论ECG评分是评估急性PTE严重程度的良好指标。Objective To evaluate the value of a 21 electrocardiographic （ECG） score system in predicting the severity of acute pulmonary thromboembolism （APTE）. Methods The clinical records of patients with a diagnosis of APTE .were retrospectively reviewed who admitted to our department from May 1999 to December 2006. The collected information and data included ： （ 1 ） Patient general clini- cal characteristics; （2） Records of 12-lead ECG abnormalities and calculation the ECG Score; （3） The area of pulmonary perfusion defect scan （PPDS） using a semi-quantitative methods on lung perfusion/ventilation scan; （4） The diastolic diameter of the right ventricle （DDRV） and systolic pulmonary artery pressure （SPAP） calculated by ultrasonic echocardiograms ; （5） Arterial blood gas analysis values of PH, PaCO2 and PaO2. （6） The sensitivity and specificity of ECG score to predict PPDS 〉 50% and SPAP 〉 50 mmHg using receiver operator characteristic （ROC） curve. Results 40 patients were enrolled in our study, with male of 23 and female of 17, age of 50. 6 （13.8 years old range 19 -76）. 21 patients had PPDS 〉50% and 13 had SPAP 〉50 mmHg. ECG score was positively correlated with the values of PPDS, DDRV and the grade of SPAP （ r = 0. 779, 0. 532 and 0. 469 respectively, all P 〈 0. 01 ） ; and was negatively correlated with PaO2 （ r = - 0. 353, P 〈 0. 05 ）. Using PPDS = 50% and SPAP = 50 mmHg as the diagnostic cut-point, the areas under the curve on ROC were 0. 888 and 0. 763 respectively. ECG score 〉 9.5 and 〉 11.5 could predict PPDS 〉 50% and SPAP 〉 50 mmHg with sensitivities of 76.2% and 70. 0%, specificities of 84. 2% and 73.9% respectively. Conclusion The Daniel ECG score is a good parameter to predict the severity of APTE.

关 键 词：肺血栓栓塞症 心电图评分 肺灌注 肺动脉高压 右心功能不全 

分 类 号：R563.5[医药卫生—呼吸系统] R576.07[医药卫生—内科学]