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| 心电图对急性肺动脉栓塞和急性非ST段抬高型心肌梗死鉴别诊断的价值 |
| 周林海1,梁碧荣2,张怀勤1,黄伟剑1,林捷1,计光1,胡建琼1,虞晓武3 |
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(1. 温州医学院附属第一医院心内科,温州 325000
2. 温州市中西医结合医院影像科,温州 325000
3. 温州医学院附属第三医院心内科,瑞安 325200) |
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| 摘要: |
| 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。 |
| 关键词: 心电图 急性肺动脉栓塞 非ST段抬高型心肌梗死 |
| DOI：10.3724/SP.J.1008.2012.058 |
| 投稿时间：2011-07-28修订日期：2011-12-22 |
| 基金项目: |
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| Value of standard 12-lead electrocardiogram in differential diagnosis of acute pulmonary embolism and non-ST elevation myocardial infarction |
| ZHOU Lin-hai1,LIANG Bi-rong2,ZHANG Huai-qin1,HUANG Wei-jian1,LIN Jie1,JI Guang1,HU Jian-qiong1,YU Xiao-wu3 |
(1. Department of Cardiology, First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, Zhejiang, China
2. Department of Radiology, Hospital of Chinese and Western Integrative Medicine, Wenzhou 325000, Zhejiang, China
3. Department of Cardiology, Third Affiliated Hospital of Wenzhou Medical College, Ruian 325200, Zhejiang, China) |
| Abstract: |
| Objective To study the values of standard 12-lead electrocardiogram (ECG) in differential diagnosis of acute pulmonary embolism (APE) and non-ST elevation myocardial infarction (NSTEMI). MethodsA retrospective analysis was conducted on 126 patients who were treated in the First Affiliated Hospital of Wenzhou Medical College during Jan. 2005 to Jan. 2011. The patients included 42 patients with APE (mean age [61±12] year) and 84 with NSTEMI (mean age [72±15] year). The data of all patients were complete and true, and the two groups were comparable in age and sex distribution. The standard 12-lead ECG records on admission were analyzed and the parameters which could be used for differential diagnosis were screened. Results Frequencies of right bundle branch block (RBBB) and SⅠQⅢTⅢ or SⅠSⅡSⅢ pattern were similar in the two groups ([11.9%] APE vs [14.3%] NSTEMI, [26.2%] APE vs [15.5%] NSTEMI patients, respectively). Negative T waves in leads Ⅴ1-Ⅴ3 together with negative T waves in inferior wall leads Ⅱ, Ⅲ, aVF (OR 1.32, 95%CI[1.15-1.69]) yielded a positive predictive value of 88% and specificity of 82% for APE. However, ST depression in leads Ⅴ5-Ⅴ6 and negative T waves in leads Ⅴ5-Ⅴ6 (OR 1.85, 95%CI [1.14-3.01]) yielded a positive predictive value of 89% and specificity of 50% for NSTEMI. ConclusionRBBB and SⅠQⅢTⅢ or SⅠSⅡSⅢ pattern may not help to differentiate between APE and NSTEMI. Coexistence of negative T waves in precordial leads Ⅴ1-Ⅴ3 and inferior wall leads Ⅱ, Ⅲ, aVF may suggest APE diagnosis. Coexistence of negative T waves and ST segment depression in precordial leads Ⅴ5-Ⅴ6 may suggest NSTEMI diagnosis. |
| Key words: electrocardiogram acute pulmonary embolism non-ST elevation myocardial infarction |
