心电图QRS和S波变化百分比是诊断急性肺栓塞的重要依据  

Percentage of QRS and S wave changes in electrocardiogram is an important basis for the diagnosis of acute pulmonary embolism

作　　者：陈春兰[1] 许和平[1] 卓小岸[1] 邝蕾[1] 李锦蝶 CHEN Chun-lan;XU He-ping;ZHUO Xiao-an;KUANG lei;LI Jin-die(Emergency Department of Hainan General Hospital,Haikou 570311,China)

机构地区：[1]海南省人民医院急诊科,海南海口570311

出　　处：《内科急危重症杂志》2021年第4期304-306,314,共4页Journal of Critical Care In Internal Medicine

摘　　要：目的:探讨心电图QRS和S波变化百分比对急性肺栓塞(APE)的诊断价值。方法:对2016年1月-2017年12月海南省人民医院急诊科收治的118例疑似APE的患者进行CT肺动脉造影(CTPA),其中102例患者具有完整的心电图和CT图像。分析102例患者心电图QRS和S波变化对APE的诊断价值。结果:心电图记录分析显示V 4~V 6导联的QRS和S波变异发生率最高(P=0.002)。2组患者在QRS波持续时间、QRS波最大和最小振幅、QRS波变异百分率、最小S波振幅、ΔS波振幅、S波变异率方面有显著性差异(P均<0.01)。多元Logistic回归分析发现QRS变化的百分比[OR:1.227(每增加1%),95%CI:1.018~1.456,P<0.01]和S波变化百分比[OR:1.072(每增加1%),95%CI:1.011~1.137,P<0.01]是APE的独立预测因子。结论:对突发胸痛、呼吸困难的疑诊APE患者,心电图V 4~V 6导联的QRS和S波变化的百分比有可能成为诊断APE的重要依据。Objective:To investigate the diagnostic value of the percentage change of QRS and S wave in electrocardiogram(ECG)for acute pulmonary embolism(APE).Methods:Totally,118 patients with suspected APE treated in the Emergency Department of Hainan General Hospital from January 2016 to December 2017 underwent CT pulmonary angiography(CTPA),of which 102 patients had complete ECG and CT images.The diagnostic value of QRS and S wave changes in ECG in 102 patients with APE was analyzed.Results:ECG analysis showed that the incidence of QRS and S wave variation in lead V4-V6 was the highest(P=0.002).There were significant differences in QRS wave duration,maximum and minimum QRS wave amplitudes,percentage of QRS wave variation,minimum S wave amplitude,and wave amplitude and S wave variation rate between the two groups(P<0.01).Multiple logistic regression analysis showed that the percentage of QRS change[OR:1.227(every increase of 1%),95%Cl:1.018-1.456,P<0.01]and the percentage of S wave change[OR:1.072(every increase of 1%),95%Cl:1.011-1.137,P<0.01]were independent predictors of APE.Conclusion:For patients suspected of APE with sudden chest pain and dyspnea,the percentage of QRS and S wave changes in ECG lead V4-V6 may be an important basis for the diagnosis of APE.

关 键 词：QRS波 S波 急性肺栓塞 

分 类 号：R563.5[医药卫生—呼吸系统]