急性肺血栓栓塞症288例心电图动态分析

目的 探讨急性肺血栓栓塞症(PTE)患者治疗前后心电图表现的动态变化.方法 将2002年6月至2005年12月全国多中心明确诊断的288例PTE患者分为大面积及次大面积组(A组)136例,非大面积组(B组)152例,其中男168例,女120例,年龄25～82岁,平均(55±14)岁.A组使用尿激酶或重组组织型纤溶酶原激活剂(rt-PA)进行溶栓治疗,B组使用普通肝素或低分子肝素抗凝治疗.在治疗前和治疗后14 d内观察患者心电图的表现,分析各段各种异常心电图的发生率,及A组和B组之间的差异.结果 SⅠ QⅢ TⅢ最高发生率为A组32.4%,B组21.7%,QⅢ波型:A组达69.1%,B组56.6%;TⅢ波型:A组63.2%,B组43.4%,SⅠ TⅢ波型:A组40.7%,B组25.7%,改变呈逐渐下降趋势且各时段间差异有统计学意义(P＜0.05);治疗前胸前导联Tv1倒置A组达77.8%,B组52.0%,Tv1-Tv5倒置依次变浅或消失,发生率呈下降趋势,各导联及各时段间差异有统计学意义;RaVR SV5振幅呈规律性递减趋势;电轴左偏A组最高发生率47.1%、B组30.3%,组间比较差异有统计学意义(P＜0.05).电轴右偏A组为16.2%,B组为15.1%,组间比较差异无统计学意义.结论 急性PTE患者心电图波型异常改变有较高发生率,对急性PTE患者的早期初步诊断有一定价值.

Analysis of the electrocardiographic findings in 288 patients with acute pulmonary thromboembolism

Objective To research variety orderliness of electrocardiogram in patients with acute pulmonary thromboembolism(PET). Method 288 patients with first episode of acute PET were included in the study: There were 136 patients with massive and sub massive PTE (group A) and 152 with non-massivePET (group B). Thrombolytic agents were used for patients in group A and anticoagulant agents for those in group B. The electrocardiographic patterns of these patients were observed on 6 time points during the course. The rate of electrocardiographic abnormalities and differences between groups were analyzed. Result A high rate of S 1 Q Ⅲ T Ⅲ change was observed, 32. 4% (44/136 ) in group A and 21.7 % ( 33/152 ) in group B. QⅢ ,TⅢ ,and S Ⅰ TⅢ were also very common. Negative T-waves in precordial leads were present in 77. 8%(105/136) of patients in group A,and 52. 0% (79/152) in group B. The amplitude of RavR and Sv5 was decreased gradually and regularly after treatment. The highest rate of left axis deviation was 47.06% in group A and 30. 26% in group B, the difference being significant between the 2 groups. The occurrence of right axis deviation was lower, 16.2% (22/136)in group A and 15. 1% (23/152)in group B, with no significant difference. Conclusion The electrocardiographic findings were useful in the early diagnosis of PTE.