心电图在肺栓塞诊断中的研究

目的 通过对肺栓塞及有相似临床表现的几组疾病心电图的对比,试图了解肺栓塞心电图的特点和心电图在肺栓塞诊断及鉴别诊断中的应用及意义.方法 共入选364例肺栓塞病例.其中肺栓塞组197例,对照组共167例.对照组分为:1组冠心病心力衰竭组70例,2组原发性高血压心力衰竭组47例,3组急性肺损伤/急性呼吸窘迫综合征组50例.对364例患者的心电图等临床资料进行分析.结果 肺栓塞组心电图出现电轴右偏、顺钟向转位、右束支传导阻滞、肺型P波、V1导联S波粗顿或挫折等与对照组相比明显增加,差异有统计学意义;S1Q3T3、胸前导联T波倒置出现的比率也是肺栓塞组最高,差异有统计学意义.结论 肺栓塞患者心电图的表现以右心负荷增加和反射性的冠状动脉缺血为主要表现;S1Q3T3可能是电轴右偏的表现;每一个指标的敏感性和特异性都难以承担诊断和鉴别诊断的重任;动态观察心电图对肺栓塞的诊断意义重大.

Study of electrocardiograph in differential diagnosis of pulmonary embolism

Objective To explore the characteristics,application and significance of electrocardiogragh (ECG)in diagnosis and differential diagnosis of pulmonary embolism(PE)by contrasting the ECG of PE and several diseases with similiar clinical features.Methods A total of 364 cases were enrolled in this study,including 197 cases of PE,70 cares of coronary artery disease(CAD)with congestive heart failure(CHF),47 cases of essential hypertension(EH)with CHF,and 50 cases of acute lung injury/acute respiratory distress syndrome(ALI/ARDS).The ECG of these 364 PE cases were analyzed.Results The rates of axle right drift,lockward rotation,right bundle branch block and pulmonary P wave,V1 lead s-wave were higher than control groups,with significant difference.Bates of S1Q3T3,disposition of T wave in chest lead were the highest in PE group,with significant difference.Conclusion The main appearances of ECG in PE patients hint the heavy load of right ventricular and coronary ischemia.Perhaps S1Q3T3 is the appearance of axle right drift.The sensitivity and speciality of every feature is not good enough to diagnosis or differential diagnosis;dynamic observation of ECG is of great significance to the diagnosis of PE.