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目的 探讨右胸导联心电图对急性肺栓塞的诊断价值。方法 回顾分析1999年3月至2003年10月收治的98例可疑肺栓塞患者的标准12导联和右胸导联(V3R、V4R和V5R)心电图,对左、右胸导联心电图进行测量和比较。结果 98例中只有23例确诊为急性肺栓塞,其中男18例,女5例,平均年龄(48±10)岁。23例中18例(78% )左、右胸导联均有右心室劳损表现; 13例(72% )的心电图异常改变在入院或症状发作后24h内消失; 9例(39% )同时存在常规12导联心电图异常和右胸导联的ST段抬高; 5例(22% )左胸导联心电图正常,而右胸导联ST段抬高并呈qr、QS型;右胸导联ST段抬高的发生率为56 5% (13 /23); 20例(87% )V3R导联呈qr型。结论 急性肺栓塞时常有右胸导联心电图的特征性改变。当怀疑肺栓塞时,特别是当常规12导联无典型改变时,应描记右胸导联心电图。
Objective To investigate the diagnostic value of right chest lead ECG in acute pulmonary embolism. Methods The standard 12-lead and right-chest leads (V3R, V4R and V5R) electrocardiograms were retrospectively analyzed in 98 patients with suspected pulmonary embolism from March 1999 to October 2003, Compare Results Of the 98 cases, only 23 cases were diagnosed as acute pulmonary embolism, including 18 males and 5 females, with an average age of (48 ± 10) years. In 23 cases, 18 cases (78%) had right ventricular strain manifestations in both left and right chest leads; 13 cases (72%) had abnormal electrocardiogram disappeared within 24 hours after admission or symptom onset; 9 cases (39% Conventional 12-lead electrocardiogram and right chest lead ST segment elevation; 5 cases (22%) left chest lead electrocardiogram normal, while right chest lead ST segment elevation and qr, QS type; right chest lead The incidence of ST segment elevation was 56.5% (13/23); 20 cases (87%) of V3R showed qr type. Conclusions Acute pulmonary embolism often has a characteristic change of right chest lead ECG. When suspected of pulmonary embolism, especially when there is no typical change in the conventional 12 lead, right chest lead ECG should be traced.