急性肺血栓栓塞症临床心电图分析研究

目的探讨急性肺血栓栓塞症（PTE）患者发病前后心电图（ECG）动态变化，进一步提高ECG在PTE中的诊断价值。方法病例选自我院2004年1月～2009年1月住院期间经X线胸片、螺旋CT、放射性核素肺通气灌注扫描或肺动脉造影明确诊断的46例PTE患者，主要分析PTE患者发病前后ECG的动态变化。结果464例PTE患者出现ECG动态变化者44例，占96％。其中以窦性心动过速及房性心律失常出现最早，占50％。额面心电轴右偏〉90度、S1QⅢTⅢ、SⅠS ⅡSⅢ综合征、重度顺钟向转位、右束支传导阻滞、TV1-V4倒置等一系列急性肺源性心脏病的ECG表现，占40％。ST段呈缺血性及损伤性改变甚至出现心肌坏死样图形占10％。结论急性肺血栓栓塞症心电图虽然是非特异性，但ECG能为临床提供最早最快最敏捷的诊断资料，将ECG的动态变化与临床症状紧密结合，对PTE的早期诊断具有重要价值。

Research on Electrocardiogram of Acute Pulmonary Thromboembolism

Objective To investigate the dynamic electrocardiogram （ECG） before and after acute pulmonary thromboembolism （PTE） and improve the diagnostic value of ECG in the PTE. Methods 46 cases of patients with the PTE, diagnosed clearly by the chest X-ray, spiral CT and radionuclide lung ventilation perfusion scan or pulmonary angiography, were selected from Jan. 2004 to Jan. 2009 in our hospital patients. Dynamic electrocardiograms of all cases were analyzed before and after acute pulmonary thromboembolism. Results 44 cases were shown dynamic ECG changes in all 46 patients with PTE, accounting for 96%. Changes of ECG with sinus tachycardia and atrial arrhythmias appeared first, accounting for 50%. These of ECG with electrical axis right deviation of frontal plane exceeding 90 degree, symptom complex of S1QI]]TIII. S I SISII], heave clockwise rotation, right bundle branch block, and inversion of TV, 4 et al accounted for 40%. ECG of ischemic and injure, even appearing myocardiolysis in ST stage accounted for 10%.Conclusions When acute pulmonary thromboembolism occurred, the dynamic changes of the ECG have significance value in early diagnosis of PTE on condition that closely linked toclinical symptoms.