心电图在肺心病病程变化和预后判断中的作用  

Role of Electrocardiography in Determination of Course Change and Prognosis inPatients with Cor Pulmonale

作　　者：易仁亮[1] 邹霞英[2] 辛达临[3] 江亚文[1] 郭振辉[2] 

机构地区：[1]广州军区广州总医院老年病一科,510010 [2]广州军区广州总医院呼吸科,510010 [3]广州军区广州总医院心内科,510010

出　　处：《天津医药》2003年第11期707-709,共3页Tianjin Medical Journal

摘　　要：目的 :评价心电图在慢性肺心病肺动脉压力变化及判断预后中的作用。方法 :对150例进行过右心导管肺动脉压力测定和心电图检查的缓解期慢性肺心病患者随访观察5年 ,5年后对全部存活患者重复行右心导管肺动脉压力测定和心电图检查。结果 :(1)150例患者,5年随访期内死亡83例 ,病死率为55.33 %;心电图观察指标如QRS电轴≥90°、V1R/S≥1、R V1+S V5≥1.05mV在死亡组和存活组有明显差异 ,平均肺动脉压 (mPAP)大于30mmHg 者 ,其5年累积生存率明显降低。(2)25例平均肺动脉压 (mPAP)波动≥5mmHg 者 ,心电图均有改变 ,21例mPAP上升 ,4例下降 ,前者心电图改变呈右房室负荷增加 ,后者呈右房室负荷降低。结论 :(1)QRS电轴≥90°、V1 R/S≥1、R V1+S V5≥1.05mV等心电图指标出现或肺动脉压力大于30mmHg提示预后不良。(2)心电图随访可作为评估肺动脉压力动态变化的一种手段。Objective:To evaluate the role of electrocardiography(ECG)in determination of course change and prognosis in patients with cor pulmonale.Methods:After 5-year follow-up of 150 patients with cor pulmonale,the ECG and Swan-Ganz catheterization were performed again in 67 survivals.Results:(1)Their mortality was 53.33%(83/150).There were significant differences in ECG indices,such as QRS electrical axis≥90°,V1R/S≥1 and RV1+SV5≥1.05 mV,between the dead and the survivals.The survival rate significantly decreased in patients with over 30 mmHg of mean pulmonary arterial pressure(mPAP).(2)There were changes in all 25 patients with over 5 mmHg fluctuation of mPAP;mPAP and right ventricular load in ECG increased in 21,and decreased in 4.Conclusion:(1)The indicators of poor prognosis were QRS electrical axis ≥90°,V1R/S≥1 and RV1+SV5≥1.05 mV or above 30 mmHg of mPAP.(2)ECG may be regarded as a measure to evaluate the dynamic changes of PAP.

关 键 词：心电图 肺心病 病程 预后 肺动脉压力 

分 类 号：R541.5[医药卫生—心血管疾病] R540.41[医药卫生—内科学]