[1]张静华,王随峰,施 念,等.心电图在判断急性肺栓塞发生部位中的应用价值[J].郑州大学学报(医学版),2018,(04):485-488.[doi:10.13705/j.issn.1671-6825.2017.11.160]
 ZHANG Jinghua,WANG Suifeng,SHI Nian,et al.Value of ECG in estimating location of embolism of patients with acute pulmonary embolism[J].JOURNAL OF ZHENGZHOU UNIVERSITY(MEDICAL SCIENCES),2018,(04):485-488.[doi:10.13705/j.issn.1671-6825.2017.11.160]
点击复制

心电图在判断急性肺栓塞发生部位中的应用价值()
分享到:

《郑州大学学报(医学版)》[ISSN:1671-6825/CN:41-1340/R]

卷:
期数:
2018年04期
页码:
485-488
栏目:
应用研究
出版日期:
2018-07-20

文章信息/Info

Title:
Value of ECG in estimating location of embolism of patients with acute pulmonary embolism
作者:
张静华王随峰施 念刘桂芝郭 华
郑州大学第一附属医院物理诊断科 郑州 450052
Author(s):
ZHANG JinghuaWANG SuifengSHI NianLIU GuizhiGUO Hua
Department of Physical Diagnosis,the First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052
关键词:
肺栓塞 心电图 肺动脉干 主肺动脉
Keywords:
pulmonary embolism electrocardiogram pulmonary trunk main pulmonary artery
分类号:
R543.2
DOI:
10.13705/j.issn.1671-6825.2017.11.160
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。
Abstract:
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.

参考文献/References:

[1] TAPSON VF.Acute pulmonary embolism[J]. N Engl J Med,2008,358(10):1037
[2] WOOD KE. Major pulmonary embolism: review of a pathophysiologic approach to the golden hour of hemodynamically significant pulmonary embolism[J]. Chest,2002,121(3):877
[3] PULIDO T,ARANDA A,ZEVALLOS MA,et al. Pulmonary embolism as a cause of death in patients with heart disease: an autopsy study[J]. Chest,2006,129(5):1282
[4] 中华医学会心血管病学分会肺血管病学组.急性肺栓塞诊断与治疗中国专家共识(2015)[J].中华心血管病杂志,2016, 44(3):197
[5] ABARCA E,BADDI A,MANRIQUE R.ECG manifestations in submassive and massive pulmonary embolism. Report of 4 cases and review of literature[J].J Electrocardiol,2014,47(1):75
[6] 郭继鸿.心电图学[M].北京:人民卫生出版社,2002.
[7] SOGAARD KK,SCHMIDT M,PEDERSEN L,et al.30-year mortality after venous thromboembolism:a population-based cohort study[J].Circulation,2014,130(10):829
[8] 陈新,黄宛.临床心电图学[M].6版.北京:人民卫生出版社,2009.
[9] ZHANG JH,LIU GZ,WANG SF,et al.The electrocardiographic characteristics of an acute embolism in the pulmonary trunk and the main pulmonary arteries[J].Am J Emerg Med,2016,34(2):212
[10]PICCIRILLO G,MAGRI D,OGAWA M,et al.Autonomic nervous system activity measured directly and QT interval variability in normal and pacing-induced tachycardia heart failure dogs[J].J Am Coll Cardiol,2009,54(9):840
[11]KUCHER N,GOLDHABER SZ.Management of massive pulmonary embolism[J].Circulation,2005,112(2):e28
[12]ZHAN ZQ BO Y,NIKUS KC,et al. Correlation between ST-segment elevation and negative T waves in the precordial leads in acute pulmonary embolism:insights into serial electrocardiogram changes[J].Ann Noninvasive Electrocardiol,2014,19(4):398
[13]CHOI BY,PARK DG.Normalization of negative T-wave on electrocardiography and right ventricular dysfunction in patients with an acute pulmonary embolism[J].Korean J Intern Med,2012,27(1):53

相似文献/References:

[1]陈晖.青年肺栓塞19例临床分析[J].郑州大学学报(医学版),2009,(04):902.
[2]刘桂芝.急性肺动脉干栓塞的心电图特征[J].郑州大学学报(医学版),2013,(01):134.
[3]冯宇旋,单世民,黄伸伸,等.急性肺栓塞患者心电图表现与临床预后的关系[J].郑州大学学报(医学版),2015,(05):644.
 FENG Yuxuan,SHAN Shimin,HUANG Shenshen,et al.Relationship between ECG and clinical outcome in patients with acute pulmonary embolism during hospitalization[J].JOURNAL OF ZHENGZHOU UNIVERSITY(MEDICAL SCIENCES),2015,(04):644.
[4]闫书妹,常 超,衡紫微,等.压力超负荷左心室肥大过程中兔心电图的变化*[J].郑州大学学报(医学版),2016,(02):217.
 YAN Shumei,CHANG Chao,HENG Ziwei,et al.Dynamic alterations of electrocardiogram during development of pressure over-load cardiac hypertrophy of rabbits[J].JOURNAL OF ZHENGZHOU UNIVERSITY(MEDICAL SCIENCES),2016,(04):217.

备注/Memo

备注/Memo:
【作者简介】张静华,通信作者,女,1982年4月生,博士,副主任医师,研究方向:心脏电生理,E-mail:13837199122@163.com
更新日期/Last Update: 2018-06-20