论文部分内容阅读
目的研究标准12导联心电图区分急性肺动脉栓塞(APE)和急性非ST段抬高型心肌梗死(NSTEMI)的诊断价值。方法回顾性分析2005年1月至2011年1月间温州医学院附属第一医院呼吸内科和心内科收治的126例患者资料,其中42例确诊为APE(APE组),平均年龄(61±12)岁;84例确诊为NSTEMI(NSTEMI组),平均年龄(72±15)岁。所有患者资料完整、真实,两组患者在年龄、性别分布上具有可比性。分析两组患者标准12导联心电图变化,寻找可用于区分两组的指标。结果 APE和NSTEMI两组仅有部分患者心电图表现为完全性右束支传导阻滞(RBBB,11.9%和14.3%),SⅠQⅢTⅢ或SⅠSⅡSⅢ模式(26.2%和15.5%)。Ⅱ、Ⅲ、aVF合并Ⅴ1～Ⅴ3导联T波倒置是APE的重要预测因子[OR(95%CI)值为1.32(1.15,1.69)],预测APE特异性为88%,阳性预测值为82%。Ⅴ5～Ⅴ6导联T波倒置合并ST段压低是NSTEMI的重要预测因子[OR(95%CI)值为1.85(1.14,3.01)],特异性为89%,阳性预测值为50%。结论心电图的RBBB、SⅠQⅢTⅢ或SⅠSⅡSⅢ模式不能对鉴别APE和NSTEMI提供帮助;而Ⅱ、Ⅲ、aVF合并Ⅴ1～Ⅴ3导联T波倒置应高度怀疑APE的可能,Ⅴ5～Ⅴ6导联T波倒置合并ST段压低应考虑NSTEMI的可能。
Objective To study the diagnostic value of a standard 12-lead electrocardiogram in distinguishing between acute pulmonary embolism (APE) and acute non-ST-segment elevation myocardial infarction (NSTEMI). Methods A retrospective analysis of 126 patients admitted to Department of Respiratory Medicine and Cardiology of the First Affiliated Hospital of Wenzhou Medical College from January 2005 to January 2011 was conducted. Among them, 42 cases were diagnosed as APE (APE group), with an average age of 61 ± 12 ) Years old; 84 cases were diagnosed as NSTEMI (NSTEMI group), mean age (72 ± 15) years old. All patient information is complete and true. The two groups of patients are comparable in age and gender distribution. The standard 12-lead electrocardiogram changes were analyzed in both groups looking for an index that could be used to distinguish between the two groups. Results Electrocardiogram showed complete right bundle branch block (RBBB, 11.9% and 14.3%), SⅠQⅢTⅢ or SⅠSⅡSⅢ pattern (26.2% and 15.5%) in only APE and NSTEMI groups. T wave inversion of Ⅱ, Ⅲ, aVF combined with V 1 ~V 3 lead was an important predictor of APE [OR (95% CI) 1.32 (1.15, 1.69)]. The APE specificity was 88% and the positive predictive value was 82 %. The inversion of T wave and ST segment depression in leads of V5 ~ V6 are important predictors of NSTEMI [OR (95% CI) 1.85 (1.14, 3.01)] with a specificity of 89% and a positive predictive value of 50%. Conclusion ECG RBBB, SⅠQⅢTⅢ or SⅠSⅡSⅢ mode can not help to distinguish APE and NSTEMI; and Ⅱ, Ⅲ, aVF combined with V 1 ~ V 3 lead T wave inversion should highly suspect the possibility of APE, V5 ~ V6 lead T wave inversion combined ST Segment depression should consider the possibility of NSTEMI.