摘要
为探讨心电图在急性肺动脉栓塞 (简称肺栓塞 )诊断与对治疗效果评价中的作用 ,回顾性分析 18例急性肺栓塞患者入院时、溶栓后及治疗 2～ 4周后的心电图变化。研究显示 :①急性大块肺栓塞后即可出现sⅠqⅢ 及右束支阻滞的心电图表现 ;②TⅢ 及TV1 ～V3倒置往往在发病 1～ 2h后按一定的顺序相继出现 ,依次为TV1 →TV2 →TV3→TV4 ,倒置的深度TV1 →TV2 →TV3→TV4 ;经适当的治疗 ,随病情好转 ,上述导联倒置T波恢复的顺序则相反 ;③经溶栓或抗凝治疗后 ,下列心电图变化是病情缓解或肺动脉开通的征象 :a .窦性心动过速消失 ;b .Ⅰ和V5～V6导联的s波明显缩小甚至消失 ;c.V1～V3 (V4)导联T波倒置加深 ;d .右束支阻滞消失 ;e .TⅢ 、qⅢ 及rⅢ 的变化则呈双向性 ,当肺栓塞发病后数小时至 3天内即溶栓者溶栓后rⅢ 递减、qⅢ 进行性加深增宽、TⅢ 倒置进行性加深 ;反之 ,肺栓塞发病一周后进行溶栓者溶栓后qⅢ 明显缩小、TⅢ 由倒置很快变直立。结论 :急性肺栓塞的心电图变化呈一过性及多变性 ,动态观察心电图演变有助于诊断及对疗效的判断。
To explore the value of electrocardiography(ECG) in di agnosis and the action on evaluation treatement effect in acute pulmonary embolism. Retrospctive analysis of ECG chan ges in admission, postthrombolysis and 2～4 weeks after treatement was made in 18 patients with ac ute pulmonary embolism.Results: ①The ECG changes of the right bundle branch block and s Ⅰq Ⅲ appeared immediately in acute mass pulmonary embolism;②According to regular sequence, appeared early or lately T Ⅲ and T V 1～V 3 inversion after this disease came on 1～2 hours, that wereT V 1→T V 2 →T V 3→T V 4,the inversion depth were T V 1→T V 2→T V 3→T V 4,and after patients treated wi th disease improvement,aforementioned leads T wave inversion returned to normal sequence were opposite;③After treated thrombolytic or antico agulate,following ECG changes were signs of disease improvement or pulmonary artery reperfusion:Sinus tachycar dia disappeared;S waves shrank or disappeared in leadsⅠor V 5～V 6;T wave inversion in lead V 1～V 3(V 4) were deeper;Right bundle branch block disappeared; T Ⅲ,q Ⅲ and r Ⅲ were found twofold changes, the r Ⅲ were lower ,the q Ⅲ and T Ⅲ inversion were deeper and wider when thrombolytic implemented after acute pulmon ary embolism from a few hours to a few days; conversely, the q Ⅲ were lower and the T Ⅲ were from in version to straight quickly when thrombolytic implemented after acute pulmonary embolism one week.Conclusion: The re are various abnormalities on ECG observed in patients with acute pulmonary embolism.It is of great importance to observe the dynamic ECG changes and combine closely with clinical findings.
出处
《中国心脏起搏与心电生理杂志》
2004年第5期358-361,共4页
Chinese Journal of Cardiac Pacing and Electrophysiology
关键词
心电图
肺栓塞
溶栓
诊断
急性肺动脉栓塞
治疗
发病
双向性
结论
变化
Cardiology Acute pulmonary embolism Electrocardiography Myocardial in farction Right bundle branch block
