本文選題：急性肺栓塞 + 心電圖�。� 參考：《福建醫(yī)科大學》2012年碩士論文

【摘要】：目的：由于急性肺栓塞造成肺動脈阻塞時，可引起肺動脈高壓，右心室負荷過重，至一定程度時導致右心失代償、右心擴大，出現(xiàn)急性肺源性心臟病。肺動脈阻塞減輕或再通后，肺動脈高壓和右心系統(tǒng)的變化可改善。本文通過回顧性分析40例急性肺血栓栓塞患者急性發(fā)作期心電圖變化的臨床資料，探討PTE心電圖改變特征及心電圖Daniel評分系統(tǒng)對其危險度的評估，提高對肺血栓栓塞診斷意識。 臨床資料與研究方法： 1.采用回顧性分析方法連續(xù)入選2006年9月至2011年11月在福建醫(yī)科大學附屬泉州市第一醫(yī)院心血管內(nèi)科及呼吸科住院并診斷為急性肺血栓栓塞患者40例，臨床資料包括性別、年齡等一般資料。采用2001年中華醫(yī)學會呼吸病學分會制定的肺血栓栓塞的診斷與治療指南作為診斷標準，，且所有患者均經(jīng)肺部CT平掃+增強（即螺旋CT肺動脈造影CTPA）或肺通氣/灌注核素掃描而確診。 2.對入選患者用同步12導聯(lián)心電圖描記常規(guī)12導聯(lián)及右心導聯(lián)（V3R-V5R）心電圖，并測定血清D二聚體、血氣分析、螺旋CT肺動脈造影、放射性核素肺灌注掃描、心臟彩超、雙下肢動靜脈彩超等項目。 3.將40例患者根據(jù)患者肺動脈堵塞面積情況將40份心電圖分為2組，肺動脈影像學檢查肺的栓塞面積≥2個葉或7個段（雙側肺葉記20個段）或肺通氣/灌注核素掃描及肺動脈造影示肺血管床栓塞面積≥50%的為A組，共22份心電圖；栓塞面積＜2個葉或7個段的為B組，共18份心電圖。 4.對A、B兩組患者的心電圖進行Daniel評分。 5.分析其肺血管床栓塞面積大小與心電圖表現(xiàn)進行對比。采用SPSS16.0軟件進行統(tǒng)計，計量資料檢驗方法用t檢驗，計數(shù)資料用卡方檢驗。P0.05具有統(tǒng)計學意義。 結果 1.總共40份心電圖中，正常項15%，異常項85%；A組22份，正常項1例，異常項21例；B組18份，正常項6例，異常項12例。 2.大面積肺栓塞組心電圖異常項比例及心電圖Daniel評分明顯高于小面積肺栓塞組。 結論 肺栓塞心電圖改變與肺血管阻塞面積有關，而且是非特異性、非診斷性和有價值的，正確應用有助于肺栓塞診斷。并且心電圖Daniel評分值大小與肺栓塞血管床阻塞面積大小正相關，從而有助于評估肺栓塞患者的危險度。
[Abstract]:Objective: pulmonary hypertension, overload of right ventricle, decompensation of right heart to some extent, enlargement of right heart and acute pulmonary heart disease can be caused by pulmonary artery obstruction caused by acute pulmonary embolism. Pulmonary hypertension and changes in the right heart system can be improved after pulmonary artery occlusion is alleviated or recanalized. The clinical data of electrocardiogram (ECG) changes in 40 patients with acute pulmonary thromboembolism during acute attack were analyzed retrospectively. The characteristics of PTE ECG changes and the risk assessment of Daniel scoring system were discussed to improve the diagnostic awareness of pulmonary thromboembolism. Clinical data and research methods: 1. From September 2006 to November 2011, 40 consecutive patients with acute pulmonary thromboembolism were admitted to the Department of Cardiovascular and Respiratory Medicine, Quanzhou first Hospital affiliated to Fujian Medical University, and diagnosed as acute pulmonary thromboembolism. General information such as age. Using the guidelines for the diagnosis and treatment of pulmonary thromboembolism developed by the Chinese Medical Association Respiratory Society in 2001 as diagnostic criteria, All the patients were diagnosed by plain enhancement of pulmonary CT (i.e. spiral CT pulmonary angiography CTPA) or pulmonary ventilation / perfusion radionuclide scan. 2. Routine 12-lead and right cardiac leads V3R-V5R electrocardiogram were used to measure serum D-dimer, blood gas analysis, spiral CT pulmonary arteriography, radionuclide pulmonary perfusion scan, cardiac color Doppler ultrasound. Lower extremity arteriovenous color Doppler ultrasound and other items. 3. Forty electrocardiograms (ECG) were divided into two groups according to the area of pulmonary artery blockage in 40 patients. Pulmonary embolism area 鈮

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