心电图在判断急性肺栓塞发生部位中的应用价值
Value of ECG in estimating location of embolism of patients with acute pulmonary embolism

目的:观察急性肺栓塞(PE)患者的心电图(ECG)特点,探讨ECG的异常是否可以提示栓塞发生部位。方法:急性PE患者147人,根据肺动脉干及左右主肺动脉(MPA)是否发生栓塞将入选患者分为肺动脉干/MPA栓塞组和叶肺动脉和(或)远端分支栓塞组,所有入选患者均行常规12导联ECG检查。结果:Logistic 逐步回归分析结果显示:ECG V1导联PR段压低、右心室肥大(RVH)、V1-V3导联 STE合并V4-V6导联 ST段压低(STD)及V1-V4 导联T波倒置(NTW)4个变量可以判断PE是否发生在肺动脉干/MPA[OR(95%CI)分别为13.030(1.416～9.936)、2.239(1.909～5.075)、7.038(6.023～12.748)、0.129(0.055～0.304),P<0.05]。上述4指标判断PE发生在肺动脉干/MPA的灵敏度分别为17.5%、33.3%、15.8%和71.9%,特异度分别为98.9%、92.2%、97.8%和78.9%。结论:根据ECG的V1-V3导联 STE合并V4-V6导联 STD、RVH、V1-V4 导联NTW及V1导联PR段压低变化可以大致推测急性PE发生的部位。
Aim: To study whether electrocardiogram(ECG)is valuable in prompting the location of embolism in patients with acute pulmonary embolism(PE).Methods: A total of 147 hospitalized patients with acute PE were enrolled in this study and divided into two groups: main pulmonary artery trunk or main pulmonary artery(MPA)embolism and lobar artery or remote branch embolism.ECG abnormalities associated with acute PE were subsequently identified.Results: The stepwise logistic regression analysis showed that PR-segment depression in lead V1,RVH, STE of lead V1-V3 and STD of lead V4-V6, and NTW of lead V1-V4 could be used to estimate the location of embolism[OR(95%CI)were 13.030(1.416-9.936),2.239(1.909-5.075),7.038(6.023-12.748),0.129(0.055-0.304),P<0.05]; the sensitivity was 17.5%,33.3%,15.8%,71.9%,and the specificity was 98.9%,92.2%,97.8%,78.9%.Conclusion: The location of embolism can be roughly speculated by the change of ECG in patients with acute PE