心电图、超声心动图与CTPA在诊断急性肺栓塞中的应用  

Application of Electrocardiography,Echocardiography and CTPA in the Diagnosis of Acute Pulmonary Embolism

作　　者：张亚斌 陈丽媛[2] 陈殿森[1] ZHANG Ya-bin;CHEN Li-yuan;CHEN Dian-sen(Department of Imaging the First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471003,Henan Province,China)

机构地区：[1]河南科技大学第一附属医院影像科,河南洛阳471003 [2]河南科技大学第一附属医院中心试验室,河南洛阳471003

出　　处：《中国CT和MRI杂志》2020年第4期54-57,共4页Chinese Journal of CT and MRI

摘　　要：目的探析心电图、超声心动图与CT肺动脉造影(CTPA)在诊断急性肺栓塞中的应用。方法选取2016年4月-2018年4月我院收治的疑诊急性肺栓塞患者125例,均行心电图、超声心动图及CTPA检查,根据其影像学特征分析心电图、超声心动图与CTPA对诊断急性肺栓塞的应用价值。结果125例疑诊患者采用CTPA检查确诊为急性肺栓塞者89例,排除急性肺栓塞者36例,共检出栓子数量641个,腔内呈不均匀低密度影,左侧肺动脉栓子共55个、右侧肺动脉主干栓子187个、右下肺动脉栓子93个、支气管分支及肺叶动脉栓子306个,血管均呈不同程度的充盈缺损;确诊组心电图呈IRBBB(不完全性右束支传导阻滞)、典型的SⅠQⅢTⅢ型、V1导联T波倒置、V2导联T波倒置、V1-V2导联ST段抬高<0.1mV、心房颤动、顺钟转位征象的比例明显高于排除组(P<0.05);确诊组患者右室增大、三尖瓣反流、肺动脉高压、肺动脉血栓比例明显高于排除组(P<0.05);采用心电图诊断急性肺栓塞准确率、灵敏度、特异度分别为68.80%、84.27%、30.56%,超声心动图分别为92.00%、95.51%、83.33%,心电图联合超声心动图分别为95.20%、97.75%、88.89%,联合诊断准确率、灵敏度、特异度均较高。结论采用CTPA可准确进行急性肺栓塞疾病诊断,但其为有创检查,且价格相对昂贵,心电图联合超声心动图检查准确率、灵敏度、特异度较高,操作简单,安全性高,费用低廉,可作为早期急性肺栓塞疾病诊断的首选检查方案。Objective To investigate the application of electrocardiography, echocardiography and CT pulmonary angiography(CTPA) in the diagnosis of acute pulmonary embolism. Methods A total of 125 patients with suspected acute pulmonary embolism who were admitted to the hospital during the period from April 2016 to April 2018 were selected. Electrocardiography, echocardiography and CTPA were performed, and their value in diagnosis of acute pulmonary embolism was analyzed according to the imaging features. Results Of the 125 patients, 89 were diagnosed as acute pulmonary embolism by CTPA, with a total of 641 emboli, and 36 cases were excluded from acute pulmonary embolism. The cavity showed inhomogeneous low-density shadow. There were 55 emboli in left pulmonary artery, 187 in right main pulmonary artery, 93 in right lower pulmonary artery and 306 in bronchial branches and pulmonary lobe artery. The blood vessels showed different degrees of filling defects. The ratios of electrocardiography showing IRBBB(incomplete right bundle brunch block), typical SⅠQⅢTⅢ type, V1 lead T wave inversion, V2 lead T wave inversion, V1-V2 lead ST segment elevation < 0.1 mV, atrial fibrillation and clockwise rotation in the confirmed group were significantly higher than those in the exclusion group(P<0.05). Ratios of right ventricular enlargement, tricuspid regurgitation, pulmonary hypertension and pulmonary thrombosis were significantly higher in the confirmed group than in the exclusion group(P<0.05). The accuracy, sensitivity and specificity of electrocardiography in diagnosis of acute pulmonary embolism were 68.80%, 84.27% and 30.56%, those of echocardiography were 92.00%, 95.51% and 83.33%, and those of electrocardiography combined with echocardiography were 95.20%, 97.75% and 88.89%, respectively. The accuracy, sensitivity and pecificity of combined diagnosis were higher. Conclusion CTPA can accurately diagnose acute pulmonary embolism, but it is an invasive examination, and the price is relatively more expensive. The accuracy, sens

关 键 词：急性肺栓塞 心电图 超声心动图 体层摄影术 X线计算机 

分 类 号：R563.5[医药卫生—呼吸系统] R540.4[医药卫生—内科学]