摘要
目的:探讨Daniel心电图评分在急性非大面积肺血栓栓塞症(PTE)早期预后评估中的价值。方法:收集经CT肺动脉造影确诊的急性非大面积PTE患者158例,根据心电图评分将患者分为A组(心电图评分≥6分)89例和B组(心电图评分<6分)69例。在确诊PTE24h内完成心电图、动脉血气分析、血浆B型钠尿肽(BNP)、血肌钙蛋白I(TnI)以及超声心动图等检查,随后在治疗开始14d后复查动脉血气分析、超声心动图检查,并观察住院30d临床重点事件。分析心电图评分与患者右心室功能、呼吸功能以及住院30d内预后的关系。结果:A组与B组的动脉血p(O2)、动脉血p(CO2)、氧合指数[p(O2)/FiO2]、BNP、TnI、右室舒张末期内径(RVD)、肺动脉内径(PAD)、三尖瓣反流速率(TR)和肺动脉收缩压(PASP)的差异有统计学意义。A组与B组心电图表现在窦性心动过速、电轴右偏>90°、SIQIIITIII、V5导联R/S≤1、avR导联R波>0.5mV和胸导联T波倒置的差异有统计学意义。Daniel心电图评分≥6分预测非大面积PTE右心室功能异常的敏感度和特异度分别为89.8%和85.7%;2组住院30d内出现低碳酸血症和肺动脉高压的发生率差异有统计学意义,其中A组有4例死亡,B组无死亡病例。结论:Daniel心电图评分有助于对急性非大面积PTE患者早期预后进行评估。
Objective： To explore the clinical significance of Daniel electrocardiogram （ECG） scores for earlier prognosis in acute non-massive pulmonary thromboembolism （PTE）. Methods： A total of 158 patients with acute non- massive PTE, confirmed by computed tomographic pulmonary angiography （CTPA）, were consecutively recruited. Patients were divided into two groups according to Daniel ECG scores, including group A （n=89）, ECG score≥6 and group B （n= 69）, ECG score〈6. Patients were checked in 24-hour after being confirmed including ECG, arterial blood gas analysis （ABG）, serum markers and cchocardiography. The ABG and echocardiography were rechecked after 14-day. The clinical key things within 30-day in hospital were also observed. The relationship of ECG scores, right ventricular function, respiratory function and the prognosis within 30-day in hospital were analyzed. Results：There were statistical significant differences in p （O2）, p （COs）, oxygenation index [P（O2）/FiO2], B-type natriuretic peptide （BNP）, troponin I （TnI）, right ventricular end-diastolic diameter （RVD）, pulmonary artery inner diameter （PAD）, tricuspid regurgitation velocity （TR） and pulmonary artery systolic pressure （PASP） between group A and group B （P 〈 0.05）. There were statistical significant differences in sinus tachycardia, QRS axis〉90°, S1QmTm, V5 lead R/S ≤ 1, avR lead R〉0.5 mV and T wave inversion in chest lead among several ECG findings between group A and group B （P 〈 0.05）. At a cutoff of 6 points, the ECG score was 89.8% sensitive and 85.7% specific for the recognition of right ventricular dysfunction to non-massive PTE. There were statistical significant differences in the hypocapnia and pulmonary hypertension （PASP≥50 mm Hg） within 30 days after therapy in hospital between group A and group B （P 〈 0.01）. Four patients in group A died, and patients in group B were all survived. Conclusion ：The daniel ECG score is significant for the earlier prognosis in patients with acute non-massive PTE.
出处
《天津医药》
CAS
北大核心
2012年第12期1210-1214,共5页
Tianjin Medical Journal
关键词
急性病
肺栓塞
心电描记术
超声心动描记术
压力
肌钙蛋白Ⅰ
利钠肽
脑
血气分析
预后
acute disease
pulmonary embolism
electrocardiography
echocardiography,stress
troponin Inatriuretic peptide, brain
blood gas analysis prognosis
