急性肺栓塞的心电图特征及心电图评分系统对其危险度的评估

发布时间：2018-05-30 05:25

  本文选题：急性肺栓塞 + 心电图　； 参考：《福建医科大学》2012年硕士论文

【摘要】：目的：由于急性肺栓塞造成肺动脉阻塞时，可引起肺动脉高压，右心室负荷过重，至一定程度时导致右心失代偿、右心扩大，出现急性肺源性心脏病。肺动脉阻塞减轻或再通后，肺动脉高压和右心系统的变化可改善。本文通过回顾性分析40例急性肺血栓栓塞患者急性发作期心电图变化的临床资料，探讨PTE心电图改变特征及心电图Daniel评分系统对其危险度的评估，提高对肺血栓栓塞诊断意识。 临床资料与研究方法： 1.采用回顾性分析方法连续入选2006年9月至2011年11月在福建医科大学附属泉州市第一医院心血管内科及呼吸科住院并诊断为急性肺血栓栓塞患者40例，临床资料包括性别、年龄等一般资料。采用2001年中华医学会呼吸病学分会制定的肺血栓栓塞的诊断与治疗指南作为诊断标准，，且所有患者均经肺部CT平扫+增强（即螺旋CT肺动脉造影CTPA）或肺通气/灌注核素扫描而确诊。 2.对入选患者用同步12导联心电图描记常规12导联及右心导联（V3R-V5R）心电图，并测定血清D二聚体、血气分析、螺旋CT肺动脉造影、放射性核素肺灌注扫描、心脏彩超、双下肢动静脉彩超等项目。 3.将40例患者根据患者肺动脉堵塞面积情况将40份心电图分为2组，肺动脉影像学检查肺的栓塞面积≥2个叶或7个段（双侧肺叶记20个段）或肺通气/灌注核素扫描及肺动脉造影示肺血管床栓塞面积≥50%的为A组，共22份心电图；栓塞面积＜2个叶或7个段的为B组，共18份心电图。 4.对A、B两组患者的心电图进行Daniel评分。 5.分析其肺血管床栓塞面积大小与心电图表现进行对比。采用SPSS16.0软件进行统计，计量资料检验方法用t检验，计数资料用卡方检验。P0.05具有统计学意义。 结果 1.总共40份心电图中，正常项15%，异常项85%；A组22份，正常项1例，异常项21例；B组18份，正常项6例，异常项12例。 2.大面积肺栓塞组心电图异常项比例及心电图Daniel评分明显高于小面积肺栓塞组。 结论 肺栓塞心电图改变与肺血管阻塞面积有关，而且是非特异性、非诊断性和有价值的，正确应用有助于肺栓塞诊断。并且心电图Daniel评分值大小与肺栓塞血管床阻塞面积大小正相关，从而有助于评估肺栓塞患者的危险度。
[Abstract]:Objective: pulmonary hypertension, overload of right ventricle, decompensation of right heart to some extent, enlargement of right heart and acute pulmonary heart disease can be caused by pulmonary artery obstruction caused by acute pulmonary embolism. Pulmonary hypertension and changes in the right heart system can be improved after pulmonary artery occlusion is alleviated or recanalized. The clinical data of electrocardiogram (ECG) changes in 40 patients with acute pulmonary thromboembolism during acute attack were analyzed retrospectively. The characteristics of PTE ECG changes and the risk assessment of Daniel scoring system were discussed to improve the diagnostic awareness of pulmonary thromboembolism. Clinical data and research methods: 1. From September 2006 to November 2011, 40 consecutive patients with acute pulmonary thromboembolism were admitted to the Department of Cardiovascular and Respiratory Medicine, Quanzhou first Hospital affiliated to Fujian Medical University, and diagnosed as acute pulmonary thromboembolism. General information such as age. Using the guidelines for the diagnosis and treatment of pulmonary thromboembolism developed by the Chinese Medical Association Respiratory Society in 2001 as diagnostic criteria, All the patients were diagnosed by plain enhancement of pulmonary CT (i.e. spiral CT pulmonary angiography CTPA) or pulmonary ventilation / perfusion radionuclide scan. 2. Routine 12-lead and right cardiac leads V3R-V5R electrocardiogram were used to measure serum D-dimer, blood gas analysis, spiral CT pulmonary arteriography, radionuclide pulmonary perfusion scan, cardiac color Doppler ultrasound. Lower extremity arteriovenous color Doppler ultrasound and other items. 3. Forty electrocardiograms (ECG) were divided into two groups according to the area of pulmonary artery blockage in 40 patients. Pulmonary embolism area 鈮

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