心电图在判断急性肺栓塞发生部位中的应用价值  

Value of ECG in estimating location of embolism of patients with acute pulmonary embolism

作　　者：张静华[1] 王随峰[1] 施念 刘桂芝[1] 郭华[1] ZHANG Jinghua;WANG Suifeng;SHI Nian;LIU Guizhi;GUO Hua(Department of Physical Diagnosis,the First Affiliated Hospital,Zhengzhou University,Zhengzhou 45005)

机构地区：[1]郑州大学第一附属医院物理诊断科,郑州450052

出　　处：《郑州大学学报（医学版）》2018年第4期485-488,共4页Journal of Zhengzhou University(Medical Sciences)

摘　　要：目的:观察急性肺栓塞(PE)患者的心电图(ECG)特点,探讨ECG的异常是否可以提示栓塞发生部位。方法:急性PE患者147人,根据肺动脉干及左右主肺动脉(MPA)是否发生栓塞将入选患者分为肺动脉干/MPA栓塞组和叶肺动脉和(或)远端分支栓塞组,所有入选患者均行常规12导联ECG检查。结果:Logistic逐步回归分析结果显示:ECG V1导联PR段压低、右心室肥大(RVH)、V1-V3导联STE合并V4-V6导联ST段压低(STD)及V1-V4导联T波倒置(NTW)4个变量可以判断PE是否发生在肺动脉干/MPA[OR(95%CI)分别为13.030(1.416~9.936)、2.239(1.909~5.075)、7.038(6.023~12.748)、0.129(0.055~0.304),P<0.05]。上述4指标判断PE发生在肺动脉干/MPA的灵敏度分别为17.5%、33.3%、15.8%和71.9%,特异度分别为98.9%、92.2%、97.8%和78.9%。结论:根据ECG的V1-V3导联STE合并V4-V6导联STD、RVH、V1-V4导联NTW及V1导联PR段压低变化可以大致推测急性PE发生的部位。Aim： To study whether electrocardiogram（ ECG） is valuable in prompting the location of embolism in patients with acute pulmonary embolism（ PE）. Methods： A total of 147 hospitalized patients with acute PE were enrolled in this study and divided into two groups： main pulmonary artery trunk or main pulmonary artery（ MPA） embolism and lobar artery or remote branch embolism. ECG abnormalities associated with acute PE were subsequently identified. Results： The stepwise logistic regression analysis showed that PR-segment depression in lead V1,RVH,STE of lead V1-V3 and STD of lead V4-V6,and NTW of lead V1-V4 could be used to estimate the location of embolism[OR（ 95% CI） were 13. 030（ 1. 416-9. 936）,2. 239（ 1. 909-5. 075）,7. 038（ 6. 023-12. 748）,0. 129（ 0. 055-0. 304）,P 0. 05]; the sensitivity was 17. 5%,33. 3%,15. 8%,71. 9%,and the specificity was 98. 9%,92. 2%,97. 8%,78. 9%. Conclusion： The location of embolism can be roughly speculated by the change of ECG in patients with acute PE.

关 键 词：肺栓塞 心电图 肺动脉干 主肺动脉 

分 类 号：R543.2[医药卫生—心血管疾病]