论文部分内容阅读
目的:分析心电图表现在肺栓塞诊断和治疗过程中的应用价值,探索早期诊断治疗简便方法。方法:通过近5年来收治80例经肺螺旋CT加肺动脉造影、肺灌注通气扫描及心血管彩超等明确诊断的肺栓塞患者,分析十二道心电图,结合临床资料,结合症状、体征及常规化验早期诊断作为进行回顾分析,部分溶栓治疗患者采取自身前后对照的变化。结果:24例肺栓塞心电图未见明显异常,该组患者血流动力学相对稳定,血气分析缺氧程度较轻,预后良好。48例出现窦性心动过速,房性早搏6例,室性早搏占10例,心房扑动与心房纤颤有6例,50例患者的QRS波,显示QRS电轴右偏。其中12例出现右心室负荷加重的心电图SI加深,QⅢ出现及TⅢ倒置,即SI、QⅢ和TⅢ,胸前导联V1-4T波倒置,或完全性及不完全性右束支传导阻滞。T波倒置主要发生在Ⅱ、Ⅲ、aVF和V1-4导联,均为面积较大的肺栓塞,常伴有血流动力学的改变,血气分析表明有严重低氧血症。对比在溶栓治疗前和溶栓治疗后12导联心电图,发现溶栓后心电图T波发生普遍倒置或在原有T波改变基础上进一步加重,长期随访2例心电图恢复病前正常情况。结论:临床上心电图的动态改变要密切与相关临床资料结合判断,心电图的特征对提示肺栓塞的诊断有应用价值,在病情评估,预后判断,疗效监测多个方面也有重要参考价值。
Objective: To analyze the value of electrocardiogram (ECG) in the diagnosis and treatment of pulmonary embolism and to explore the method of early diagnosis and treatment. Methods: Twelve electrocardiograms were analyzed by clinical data of 80 patients with pulmonary embolism diagnosed by pulmonary spiral CT plus pulmonary arteriography, pulmonary perfusion ventilation and cardiovascular ultrasonography in the past 5 years. Combined with clinical data, symptoms, signs and routine tests Early diagnosis as a retrospective analysis, partial thrombolysis patients to take their own changes before and after the control. Results: There was no obvious abnormal electrocardiogram in 24 cases of pulmonary embolism. The hemodynamics was relatively stable in this group. The degree of hypoxia in blood gas analysis was lighter and the prognosis was good. 48 cases of sinus tachycardia, atrial premature beats in 6 cases, premature ventricular contractions accounted for 10 cases, atrial flutter and atrial fibrillation in 6 cases, 50 cases of QRS wave, showing right QRS axis deviation. Among them, 12 cases of right ventricular load aggravating ECG SI deepening, QIII appear and T Ⅲ inversion, namely SI, Q Ⅲ and T Ⅲ, chest lead V1-4T wave inversion, or complete and incomplete right bundle branch block. T wave inversion occurs mainly in Ⅱ, Ⅲ, aVF and V1-4 leads, are larger pulmonary embolism, often accompanied by changes in hemodynamic changes, blood gas analysis showed severe hypoxemia. Comparing the 12-lead electrocardiogram before thrombolytic therapy and after thrombolysis, we found that T wave of thrombolytic therapy generally reversed after T-thrombosis or was further aggravated by the change of original T-wave. Long-term follow-up of 2 cases of normal ECG before electrocardiogram restoration. Conclusion: The dynamic changes of clinical ECG should be closely combined with the relevant clinical data to determine the characteristics of the ECG on the diagnosis of pulmonary embolism has value, in the assessment of the disease, prognosis and monitoring of multiple aspects also have important reference value.