心电图在肺栓塞和心肌梗死早期鉴别诊断中的应用

目的评价心电图在肺栓塞(pulmonary embolism,PE)和心肌梗死(myocardial infarction,MI)早期表现中的差异,强调心电图在早期诊断与鉴别诊断中的意义。方法入组2006年10月至2010年10月间确诊为肺栓塞、心肌梗死的住院患者,分别为80、150例,分析早期(发病72h内)心电图改变并按21评分表计算积分。结果①PE组比MI组心电图正常者人数多:18/80 VS 12/150(P<0.01);②出现电轴右偏、顺钟向转位、右支传导阻滞、肺型P波、S1Q3T3、V1导联S波粗顿或挫折等的比例在PE组较高,差异有统计学意义;MI组ST段压低及抬高的比例较PE组高,差异有显著性;而窦性心动过速和S1S2S3两种表现上,两组无差别;③PE组与MI组的心电图积分:7±4.1 VS 2.1±1.6(P<0.05)。结论虽然肺栓塞中无心电图改变的比例多于心肌梗死,但是肺栓塞的右心负荷增加样心电图改变及较高的心电图积分,在早期诊断与鉴别诊断中具有重要意义。

Applications of ECG in the Early Differential Diagnosis of Pulmonary Embolism and Myocardial Infarction

Objective Evaluation the performance of ECG between pulmonary embolism and myocardial infarction in early period,Stressed the significance of ECG in the differential diagnosis.Methods 80 cases of pulmonary embolism patients and 150 cases of myocardial infarction patients were recruited from october 2006 to october 2010,Analysis of ECG changes in 72 hour after onset and scoring according to 21 points table.Results ①The comparison of the number of patients whose ECG is normal between PE group and MI group ： 19/80 VS 12/150,P0.01;②The rates of axie right drift,Iockward rotation,right bundle branch block and pulmonary P wave,Vl lead s-wave S1Q3T3were higher than MI group,with significant difference;The changes of ST segment are more in m MI group than PE group;The two kinds performance of sinus tachycardia and S1S2S3,two groups are non-discriminatory;③The comparison of ECG integral between PE group and MI group：7±4.1 VS 2.1±1.6（P0.05）.Conclusion Although the number of patients whose ECG is normal in PE group is more than MI group,However,they are important in the early differential diagnosis with myocardial infarction that the ECG changes result of right heart overload and high points in pulmonary embolism patients.