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目的:探讨心电图评分系统在急性肺栓塞(acute pul monary embolization,APE)中的应用价值。方法:选择2001~2005年入院经强化螺旋CT确诊的94例APE患者,采集24h内的标准12导联心电图,按照Daniel心电图评分系统计算得分。应用超声心动图测量APE患者肺动脉收缩压(SPAP)。结果:APE中最常见的心电图改变是胸前导联T波倒置,尤其多见于V1和V2导联,分别为69例(73.4%)和58例(61.7%)。APE患者心电图评分平均为(6.5±4.0)分,与SPAP呈正相关(r=0.801,P<0.01)。与SPAP<50mmHg患者比较,SPAP≥50mmHg患者心电图评分明显增高[(9.0±3.0)分∶(3.2±2.3)分,P<0.01]。心电图评分≥7预测SPAP≥50mmHg的敏感性、特异性、准确性、阳性预测价值、阴性预测价值分别为81.1%、95.1%、87.2%、95.6%、79.6%。结论:心电图评分系统可以对APE患者的严重程度进行危险分层。
Objective: To investigate the value of electrocardiogram scoring system in acute pulmonial embolization (APE). Methods: Ninety-four patients with APE admitted to our hospital from 2001 to 2005 were enrolled in this study. Standard 12-lead electrocardiogram was collected within 24 hours. The score was calculated according to the Daniel electrocardiography scoring system. Pulmonary artery systolic pressure (SPAP) was measured by echocardiography in patients with APE. Results: The most common electrocardiographic change in APE was T wave inversion of the thoracic aorta, especially in V1 and V2 leads, which were 69 (73.4%) and 58 (61.7%), respectively. The average score of electrocardiogram in APE patients was (6.5 ± 4.0) points, positively correlated with SPAP (r = 0.801, P <0.01). Compared with patients with SPAP <50 mmHg, the electrocardiogram score was significantly increased in patients with SPAP≥50 mmHg [(9.0 ± 3.0) points: (3.2 ± 2.3) points, P <0.01]. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of electrocardiogram score ≥7 in predicting SPAP≥50mmHg were 81.1%, 95.1%, 87.2%, 95.6% and 79.6% respectively. Conclusion: The ECG scoring system can be used to stratify the severity of APE patients.