摘要
目的 通过分析误诊为急性心肌梗塞 (AMI)的急性肺栓塞 (APE)患者资料 ,评价超声心动图在APE诊断中的作用。方法 急诊误诊为AMI的APE患者 7例 ,平均年龄 (6 5 4± 7 2 )岁 ,所有患者均按AMI动态观察血清酶、心肌肌钙蛋白T(TnT)、心电图 (ECG) ,并行动脉血气分析、床旁超声心动图 (ECHO)检查和同位素肺通气 /灌注显像。结果 APE患者表现不同程度的低氧血症 ,部分患者ECG可有V3R～ 5R及V1～ 3 导联ST T的动态改变 ;血清酶以LDH、HBDH升高为主 ,可同时伴CK、CKMB及TnT不同程度升高。APE时ECHO表现肺动脉压增高、右心室压力负荷过重 ,ECHO明显异常者发生晕厥及栓塞复发机会增加。结论 (1)APE与AMI诊断易混淆 ,即使进行血气分析、ECG、血清酶或TnT检查 ,早期鉴别APE和AMI有时也很困难。 (2 )ECHO在APE和AMI患者有不同的表现 ,是及时诊断APE的重要方法。
Objective To assess the value of echocardiography (ECHO) in the diagnosis of acute pulmonary embolism (APE) confused with acute myocardial infarction (AMI) Methods Seven patients with APE who were originally misdiagnosed as AMI in emergency room were included, with mean age of (65 4±7 2) years Serum enzymes, cardiac troponin T (TnT) determination, electrocardiogram (ECG) were done serially in accordance with AMI PaO 2, bedside ECHO and ventilation/perfusion lung scan were performed in all patients Results Patients with APE had different degree of hypoxia, and ECG showed dynamic ST T changes in leads V 3R～5R and V 1～3 in some patients LDH and HBDH elevation were the main enzymatic manifestations, accompanied by abnormality of TnT ECHO showed pulmonary hypertension and right heart overload The incidence of syncope and recurrence of embolism increased if ECHO is significantly abnormal Conclusion (1) APE may be confused with AMI Early differential diagnosis of APE and AMI may be quite difficult in some patients even if blood gas analysis, ECG and determination of serum cardiac enzymes or TnT were available (2) ECHO was an important method in timely diagnosing APE
出处
《中国介入心脏病学杂志》
2000年第2期87-89,共3页
Chinese Journal of Interventional Cardiology
关键词
急性肺栓塞
急性心肌梗塞
超声心动图
诊断
Acute pulmonary embolism
Acute myocardial infarction
Echocardiography
