急性肺动脉栓塞合并急性冠脉综合征的心电图诊断  

ECG diagnosis of acute pulmonary embolism complicating acute coronary syndrome

作　　者：张建义[1] 张羽中[2] 

机构地区：[1]桂林医学院附属医院心内科,广西桂林541001 [2]桂林医学院第二附属医院心内科,广西桂林541199

出　　处：《实用心电学杂志》2015年第6期452-456,共5页Journal of Practical Electrocardiology

摘　　要：急性肺动脉栓塞(acute pulmonary embolism,APE)合并急性冠脉综合征(acute coronary syndrome,ACS)临床情况严重,正确及时地诊断治疗尤为重要。当APE患者出现持续性胸痛、严重的右心室功能不全、顽固的房性心律失常时,应考虑APE合并ACS。最方便实用的诊断工具是心电图(ECG),其诊断标准总结如下:1 APE传统的ECG改变+左胸导联ST段改变;2 APE患者T波倒置以Ⅲ、V_1、V_2导联为主,倒置最深者在V_2导联,同时出现左胸导联T波倒置,且深度及广度均大于右胸导联;3右胸导联及aVR导联ST段抬高。It is particularly important to give patients with acute pulmonary embolism （APE） complicating acute coronary syndrome （ACS） correct and timely diagnosis and treatment for its se- verity. When persistent chest pain, serious right ventricular dysfunction, and refractory atrial ar- rhythmia occur in APE patient, APE complicating ACS should be considered. The most convenient and practical diagnostic tool is electrocardiogram（ ECG）, and the diagnostic criteria are summarized as follows ： （i） the conventional ECG changes of APE ＋ ST segment changes in left chest leads ; （ii） T wave inversions are mostly found in Ⅲ, v1, and V2 lead of APE patients, with the deepest in V2 lead while they synchronously appear in left chest leads, deeper and wider than those in right chest leads; （iii） ST segment elevation is observed in right chest leads and aVR lead.

关 键 词：急性肺动脉栓塞 急性冠脉综合征 心电图 ST-T改变 AVR导联 

分 类 号：R540.4[医药卫生—心血管疾病]