133例急性肺栓塞心电图分析  

Analysis of electrocardiographic findings in 133 patients with acute pulmonary embolism

作　　者：杨伟强[1] 陶振钢[1] 施东伟[1] 姚晨玲[1] 童朝阳[1] 林靖宇[2] 刘骏桢[3] 蔡映云[4] 

机构地区：[1]复旦大学附属中山医院急诊科,上海200032 [2]复旦大学附属中山医院心电图室,上海200032 [3]复旦大学附属中山医院放射科,上海200032 [4]复旦大学附属中山医院老年病科,上海200032

出　　处：《中国急救医学》2013年第8期698-701,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨心电图（ECG）在急性肺栓塞（APE）患者危险分层中的临床应用价值。方法对2009-03-2012-03经我院急诊确诊的133例APE患者的临床资料进行回顾性分析，根据欧洲心血管协会制定的《2008急性肺动脉栓塞诊断与治疗指南》的危险分层标准进行危险分层，并比较不同危险分层患者的心电图表现。133例APE患者中111例（83．5％）为非高危组，22例（16．5％）为高危组。结果V1-V4导联T波倒置、Ⅲ导联或V1导联sT段抬高及V1导联QR／qR型在高危组中更多见。多因素分析显示，V1～V4导联T波倒置（OR3．492，95％CI1．266-9．634，P=0．016）和V1导联QR／qR型（OR3．908，95％CI1．272～12．003，P：0．017）是预测APE患者高危组的独立危险因素。结论急诊ECG有助于APE患者的危险分层。V1-V4导联T波倒置或V1导联QR／qR波是预测APE高危组的独立危险因素。Objective To investigate the clinical value of electrocardiogram （ECG） in risk stratification of patients with acute pulmonary embolism （APE）. Methods We performed a retrospective study of 133 patients who had confirmed APE from May 2009 to May 2012. Demographics, history, clinical features, and electrocardiographic findings were analyzed. Results Based on European Society of Cardiology risk stratification, 111 （83.5%） patients were classified as non -high -risk APE group, 22 （ 16.5% ） patients as high - risk APE group. A comparison between non - risk APE group and high - risk APE group indicated that the following ECG findings were more common in high - risk APE group： negative T waves in leads V1 - V4, ST segment elevation in leads Ⅲ and Ⅴ,, qR or QR in lead V1. In multivariate analysis, T waves in leads V1 - V4 （ OR 3. 492, 95% CI 1. 266 - 9. 634, P = O. 016）, qR or QR in lead V1 （OR 3. 908, 95% CI 1. 272 - 12. 003, P = 0. 017） were independent predictors of high- risk PE group. Conclusion In our Chinese APE patients, T waves in leads V1 - V4, qR or QR in lead V1 were independent predictors of high - risk APE group. We conclude that ECG analysis may be a useful method for risk stratification of patients with APE.

关 键 词：急性肺栓塞(APE) 危险分层 心电图(ECG) 

分 类 号：R540.41[医药卫生—心血管疾病]