| 高危急性肺栓塞患者的心电图表现分析 |
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| 引用本文： | 刘继纯,傅聪,谢向荣.高危急性肺栓塞患者的心电图表现分析[J].中华全科医学,2020,18(9):1474. |
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| 作者姓名： | 刘继纯 傅聪 谢向荣 |
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| 作者单位： | 皖南医学院第一附属医院(皖南医学院弋矶山医院)心血管内科, 安徽 芜湖 241001 |
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| 基金项目： | 国家自然科学基金青年基金(81700265) |
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| 摘 要： | 目的 回顾性分析急性肺栓塞(acute pulmonary embolism,APE)患者的心电图表现,旨在探讨心电图表现与APE危险分层的关系。 方法 收集2017年2月—2020年1月在皖南医学院第一附属医院治疗的急性肺栓塞患者74例,根据《2019 ESC/ERS急性肺栓塞诊断与管理指南》危险分层分为高危组(21例)和中低危组(53例)。比较2组APE患者的心电图表现及其他辅助检查结果。 结果 高危组与中低危组APE相比较,窦性心动过速、SⅠQⅢTⅢ、右束支传导阻滞、V1呈Qr、V1~V4 NTW、QTC间期延长差异有统计学意义(均P<0.05)。对2组APE患者有差异的6种心电图表现个数、年龄、性别、静脉血栓史、外科手术/外伤史、肿瘤史、肌钙蛋白I阳性、BNP、D-二聚体进行多因素logistic回归分析,结果显示,6种心电图表现个数对是否为高危APE的优势比为6.445(P<0.05,95%CI:2.688~15.453)。根据2组有差异的心电图表现个数在中低危组和高危组分布情况,绘制ROC曲线,ROC曲线下面积(AUC)为0.912,Youden指数为0.772,敏感度为90.48,特异度为86.79,Cutoff值为>1。 结论 与中低危组APE相比较,高危组中窦性心动过速、SⅠQⅢTⅢ、右束支传导阻滞、V1呈Qr、V1-V4 NTW、QTC间期延长更多见,6种心电图表现个数越多,高危APE发生的风险越大。
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| 关 键 词： | 肺栓塞 危险分层 心电图 |
| 收稿时间： | 2020-04-28 |
Electrocardiogram analysis of high risk patients with acute pulmonary embolism |
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| Affiliation: | Department of Cardiology,the First Affiliated Hospital of Wannan Medical College(Yijishan Hospital of Wannan Medical College),Wuhu,Anhui 241001,China |
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| Abstract: | Objective To retrospectively analyze the electrocardiogram(ECG) manifestations of acute pulmonary embolism(APE) patients, aiming to explore the relationship between ECG manifestations and risk stratification of APE. Methods A total of 74 patients with APE in the First Affiliated Hospital of Wannan Medical College from February 2017 to January 2020 were collected. According to the "2019 ESC/ERS Guidelines for the diagnosis and management of APE", they were divided into high-risk group(21 cases) and medium-low risk group(53 cases). ECG manifestations and other auxiliary examination results of the two groups were compared. Results Compared with APE in High-risk and medium-low risk group, there were significant differences in the sinus tachycardia, SⅠQⅢTⅢ, right bundle branch block, V1 in Qr, V1-V4 NTW, and QTC interval prolongation(P<0.05). Multivariate logistic regression analysis was performed on the number of six ECG manifestations, age, gender, history of venous thrombosis, history of surgery/rauma, history of tumor, troponin I positive, BNP and d-dimer, the results showed that the odds ratio of six ECG manifestations for high-risk APE was 6.445(P<0.05, 95% CI: 2.688-15.453). ROC curve was drawn according to the distribution of the number of different ECG findings in the medium-low risk groups and the high risk groups, the results showed that the area under the ROC curve(AUC) was 0.912, Youden index was 0.772, sensitivity was 90.48, specificity was 86.79, and cutoff value was greater than 1. Conclusion Compared with APE in the low-risk group, sinus tachycardia, SⅠQⅢTⅢ, right bundle branch block, V1 showed Qr, V1-V4 NTW, and QTC interval prolongation are more common in the high-risk group. The more the number of six ECG manifestations, the greater the risk of high-risk APE. |
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