超声心动图及心电图联合应用判断急性肺栓塞发生部位的研究  

The study of combined use of echocardiography and electrocardiogram to estimate the location of embolism of acute pulmonary embolism

作　　者：赵丽霞 李平 张月红 张静华[3] ZHAO Lixia;LI Ping;ZHANG Yuehong;ZHANG Jinghua(Department of Function,the First People’s Hospital of Longnan,Longnan 746000,China)

机构地区：[1]陇南市第一人民医院功能科,746000 [2]河南医学高等专科学校临床医学院 [3]郑州大学第一附属医院物理诊断科

出　　处：《心肺血管病杂志》2023年第12期1263-1267,1272,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：2021年河南省科技攻关计划项目(212102310797)。

摘　　要：目的:观察急性肺栓塞(pulmonary embolism,PE)患者超声心动图及心电图(electrocardiogram,ECG)特点,探讨联合应用是否可以诊断PE发生的部位。方法:根据肺动脉干及左右主肺动脉(main pulmonary artery,MPA)是否发生栓塞将入选患者分为肺动脉干和/或MPA栓塞组和叶肺动脉和/或远端分支栓塞组。分析两组间超声心动图阳性表现发生率是否相同;筛出能反映肺动脉干和/或MPA栓塞的异常ECG;并联合超声心动图进一步判断能否提高肺动脉干和/或MPA栓塞栓塞的诊断率。结果:肺动脉干和/或MPA栓塞组超声心动图阳性表现发生率显著增高(P<0.05);Logistic逐步回归分析结果显示:ECGV1~V3 ST段抬高(ST-segment elevation,STE)合并V4~V6 ST段压低(ST-segment depression,STD)、右心室肥大(right ventricular hypertrophy,RVH)、V1~V4导联T波倒置(NTW)及V1导联PR段压低4个变量可以初步判断PE是否发生在肺动脉干和/或MPA;超声心动图和ECG联合阳性表现者,肺动脉干和/或MPA栓塞的发生率明显升高(P<0.05)。超声心动图和ECG联合检测肺动脉干和/或MPA栓塞的灵敏度、特异度、阳性预测值及阴性预测值分别为89.1%,63.4%,61.2%,90.0%,与单个ECG指标及超声心动图指标相比,超声心动图和ECG联合检测肺动脉干和/或MPA栓塞的灵敏度及阴性预测值最高。与上述单个指标相比,超声心动图和ECG联合实验的ROC曲线下面积为数值最大,为0.763。结论:超声心动图和ECG联合检测更有助于检出肺动脉干、左右MPA部位的栓塞。Objective:To observe the characteristics of echocardiography and electrocardiograms(ECG)in patients with acute pulmonary embolism(PE),and to explore whether the combination of echocardiography and ECG can indicate the location of embolism.Methods:The patients were divided into two groups:embolization in main pulmonary artery trunk/main pulmonary artery(MPA)group and in lobar artery/remote branch group.The positive performance of echocardiography was been analyzed whether the same between the two groups.Abnormal ECG which could estimate embolization in main pulmonary artery trunk/MPA were been Screen out.And the combined use of echocardiography and electrocardiogram to estimate whether this method could improve the diagnostic rate of embolization in main pulmonary artery trunk/MPA.Results:The positive rate of echocardiography was significantly higher of embolization in pulmonary trunk/MPA group(P<0.05).The Stepwise Logistic regression analysis showed that ST-segment elevation(STE)of lead V1~V3 and ST-segment depression(STD)of lead V4~V6,right ventricular hypertrophy(RVH),negative T waves(NTW)of lead V1~V4 and PR-segment depression in lead V1 could be used to estimate the location of embolism.the incidence of pulmonary trunk and/or MPA embolism was significantly increased in patients with positive change of echocardiography and ECG(P<0.05).The sensitivity,specificity,positive predictive value and negative predictive value of combined echocardiography and ECG in detecting pulmonary trunk and/or MPA embolism were 89.1%,63.4%,61.2%and 90.0%,respectively.Compared with the single echocardiography and ECG,echocardiography combined with ECG has the highest sensitivity and negative predictive value in detecting pulmonary trunk and/or MPA embolism.Compared with the single index above,the highest value of area under ROC curve came from the combined echocardiography and ECG,which was 0.763.Conclusions:The combined use of echocardiography and ECG are more useful for estimating the embolization in main pulmonary artery trunk/MP

关 键 词：肺栓塞 超声心动图 心电图 肺动脉干 主肺动脉 

分 类 号：R54[医药卫生—心血管疾病]