超声心动图及心电图对急性肺动脉栓塞的诊断价值  

Value and Efficacy of Echocardiography and Electrocardiography for Diagnosing Acute Pulmonary Artery Embolism

作　　者：杜景[1] 刘俊平[2] 白云[2] 魏新明[2] 袁先改[2] 李素娟[2] 

机构地区：[1]北京市大兴区亦庄医院超声科,北京100176 [2]河北省胸科医院,河北石家庄050041

出　　处：《中国药业》2013年第23期62-64,共3页China Pharmaceuticals

摘　　要：目的 探讨超声心动图及心电图在急性肺动脉栓塞（简称肺栓塞）的诊断作用.方法 回顾性分析36例急性肺栓塞患者入院时、溶栓后及治疗2～4周后的超声心动图及心电图变化.结果 急性大块肺栓塞后心电图即可出现SⅠQⅢ及右束支阻滞的心电图表现.TⅢ及TV1 ～ V3倒置往往在发病1～2h后按一定顺序相继出现.超声心动图显示右心系统内可见活动或附壁实质性中低等回声.右房、右室增大,主肺动脉及分支增宽,肺动脉压增高,肺动脉频谱形态见特征性的“指拳征”.肺动脉频谱加速时间及射血时间缩短.溶栓或抗凝治疗后心电图显示,窦性心动过速消失;Ⅰ和V5 ～ V6导联的S波明显缩小甚至消失;V1～V3（V4）导联T波倒置加深;右束支阻滞消失;TⅢQⅢ及RⅢ的变化则呈双向性.当肺栓塞发病后数小时至3d内即溶栓者溶栓后RⅢ递减,QⅢ进行性加深增宽,TⅢ倒置进行性加深;反之,肺栓塞发病1周后进行溶栓者溶栓后QⅢ明显缩小,TⅢ由倒置很快变直立.右房、右室、肺动脉附壁血栓消失,右室恢复正常或内径较前缩小,肺动脉内经恢复正常或较前缩小,肺动脉收缩压下降.结论 急性肺栓塞的超声心动图及心电图变化呈一过性及多变性,动态观察超声心动图及心电图结合有助于诊断及对疗效的判断.Objective To explore the efficacy of echocardiography and electrocardiography（ECG） in the diagnosis and treatement of acute pulmonary artery embolism. Methods The retrospective analysis were performed on the changes of ECG and echocardiography at admis- sion, ＇after thrombolysis and after 2-4 weeks treatement in 36 patients with acute pulmonary artery embolism. Results The ECG changes of the right bundle branch block and S IQⅢ appeared immediately in acute mass pulmonary embolism. TⅢ and TV1- V3 inver- sion appeared in certain order at 1-2 h after onset of this disease, The echocardiographic showed that there were middle and low movable or mural substantial echoes in right heart. Right atrium and ventricle were enlarged, the main pulmonary artery and their hranches were broadened and the pulmonary pressure was increased. The pulmonary artery sepectum form showed the characteristic ＂finger fist sign＂ and the pulmonary acceleration time and the ejection time were shortened. After thromholytic or anticoagulation treat- ment, ECG showed that the sinus tachycardia disappeared; S waves in leads I or V5- V6 were significantly shrank or disappeared; the T wave inversion in lead V1-V3（V4） was deepened;the right bundle branch block disappeared; the changes of TⅢQⅢ and RⅢ were bi- directional. In the patients with thrombolysis treatment within a few hours to 3 d after onset, RⅢ was decreased progressively after throm- bolysis, Q! was progressively deepened and broadened, and the TⅢ inversion was progressively deepened; conversely, when implementing thrombolysis treatment after 1 week of pulmonary embolism onset; QⅢ was significantly shrank and TⅢ was quickly changed from inver- sion to straight. The right atrial, right ventricle and pulmonary mural thrombi were disappeared, the right ventricle and pulmonary artery returned to normal or smaller than former and the pulmonary artery pressure was decreased. Conclusion The changes of echocardiogra- phy and ECG in acute pulmonary embolism are trans

关 键 词：急性肺动脉栓塞 心电图 超声心动图 右束支阻滞 

分 类 号：R540.41[医药卫生—心血管疾病] R445.1[医药卫生—内科学]