心电图在急性肺栓塞危险分层中的应用

Application of Electrocardiogram in Risk Stratification of Acute Pulmonary Embolism

摘要: 目的：探讨心电图(ECG)在急性肺栓塞(APE)危险分层中的应用。方法：收集自2016年1月至2019年12月于我院就诊的APE患者167例，根据危险度分为低危(n = 48)、中低危(n = 57)、中高危(n = 41)、高危组(n = 21)，并根据急诊诊疗需要将高危、中高危归为高风险(n = 62)，其他归为低风险(n = 105)，入院完成ECG并记录，ECG观察指标有窦性心动过速、房性心律失常、右胸导联T波倒置、碎裂QRS波(fQRS)、SIQIIITIII、aVR导联ST段抬高(STEaVR)、右束支传导阻滞(RBBB)、顺钟向转位，QRS波电交替，肢体导联低电压。探讨ECG在APE危险分层中的应用。结果：窦性心动过速、房性心律失常、右胸导联T波倒置，STEaVR、fQRS的患者中，低危组与高危组之间，低风险与高风险之间均存在差异(P < 0.05)，其中房性心律失常，右胸导联T波倒置，fQRS及STEaVR呈正相关(r = 0.227, 0.358, 0.202, 0.267, P < 0.05)。结论：常规ECG可为APE的诊断和危险度分层提供一定的参考价值。

Abstract: Objective: To explore the relation between risk stratification of APE and ECG changes. Methods: 167 patients with APE were enrolled from January 2016 to December 2019, divided into low risk (n = 48), intermediate low risk (n = 57), intermediate high risk (n = 41) and high risk (n = 21) groups according to risk stratification of APE, and the intermediate high risk APE patients were affiliated to the high risk team (n = 62), and the intermediate low risk APE patients were affiliated to the low-risk team (n = 105) according to emergent preliminary assessment. ECG were performed and recorded in all cases: sinus tachycardia, atrial arrhythmia, T wave inversion (TWI) in right precordial leads (V1 - V4), Fragmented QRS complex (fQRS), SIQIIITIII, STaVR elevation > 1 mm (STEaVR), right bundle branch block (RBBB), clockwise transposition, QRS wave electrical alternations, and limb lead low voltage to explore the application of ECG in APE risk stratification. Results: The incidences of sinus tachycardia, atrial arrhythmia, TWI in right precordial leads, fQRS, STEaVR were significantly higher in high risk group than in low risk groups, and it’s significantly higher in high risk team than in low risk team (all P < 0.05), Among them, atrial arrhythmia, TWI in precordial leads, broken QRS waves and STEaVR were positively correlated (r = 0.227, 0.358, 0.202, 0.267, P < 0.05). Conclusion: ECG is potentially valuable in prognostication and risk stratification of APE.