老年急性肺栓塞心电图变化特点与临床预后的关系分析

目的 探讨老年急性肺栓塞心电图变化特点及与临床预后的关系。 方法 选取2016年4月—2017年5月瑞安市人民医院收治的83例老年急性肺栓塞患者作为研究对象,观察患者发病48 h内的心电图异常情况,观察发病30 d内生存情况评估患者预后,并分析不同因素对患者总生存率的影响,采用Kaplan-Meier法绘制生存曲线,通过COX比例风险模型评估预后的影响因素。 结果 老年急性肺栓塞患者中正常心电图10例,异常心电图73例,异常率为87.95%;发病30 d,老年急性肺栓塞患者仍有48例生存,总生存率(OS)为57.83%;单因素分析结果显示,患者昏厥、休克、心脏病史、慢性肺病史、心率>100次/min、顺钟向转位、完全性右束支传导阻滞、房颤、肢导低电压与老年急性肺栓塞患者发病30 d内OS存在相关性(均P<0.05);COX回归分析结果显示,心率>100次/min、完全性右束支传导阻滞、休克、心脏病史是老年急性肺栓塞患者临床预后的独立影响因素。 结论 老年急性肺栓塞患者心电图异常率极高,心电图异常与临床预后密切相关,且心率>100次/min、完全性右束支传导阻滞、休克、心脏病史是老年急性肺栓塞患者预后不良的独立影响因素。 

Analysis of the relationship between the characteristics of ECG and the clinical prognosis in elderly patients with acute pulmonary embolism

Objective To investigate the relationship between the characteristics of ECG and the clinical prognosis in elderly patients with acute pulmonary embolism. Methods Eighty-three elderly patients with acute pulmonary embolism admitted in Rui'an People's Hospital were selected from April 2016 to May 2017. Abnormal ECG within 48 h and survival situation within 30 days of onset were observed. The impacts of different factors on the overall survival rate were analyzed. Kaplan Meier method was used to draw survival curve, and Cox proportional risk model was used to evaluate the influencing factors of prognosis. Results Among the elderly patients with acute pulmonary embolism, 10 were normal ECG, 73 were abnormal ECG, the abnormal rate was 87.95%. Thirty days after the onset of the disease, 48 elderly patients survived, with a total survival rate(OS) of 57.83%. The results of single factor analysis shown that there was a correlation between OS within 30 days in elderly patients with acute pulmonary embolism and coma, shock, history of heart disease, chronic lung disease, heart rate>100 times/min, clockwise rotation, complete right bundle branch block, atrial fibrillation and limb lead low voltage(all P<0.05). The Cox regression analysis showed that heart rate>100 times/min, complete right bundle branch block, shock and history of heart were independent factors influencing the clinical prognosis of elderly patients with acute pulmonary embolism. Conclusion The abnormal rate of ECG in the elderly patients with acute pulmonary embolism is very high. The abnormal rate of ECG is closely related to the clinical prognosis, and the heart rate>100 times/min, complete right bundle branch block, shock and history of heart are the independent factors influencing the poor prognosis of the elderly patients with acute pulmonary embolism.