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目的:探讨急性肺血栓栓塞症(PTE)患者V1和V6导联校正QT差异的诊断价值。方法:选择在我院行CTA检查疑似急性PTE患者89例进行研究。入院时记录基线12导联心电图,增益为10 mm/mV,纸张速度为25 mm/s。结果:在本研究入组的89例疑似PTE患者中,CTA鉴定了45例急性PTE患者和44例无PTE患者。两组中大多数患者的主诉是呼吸困难,两组之间无显著差异(P>0.05)。PTE患者的D-二聚体和高敏感肌钙蛋白水平明显高于无PTE患者(P<0.05)。PTE组中的V1导联中的QT和QTc显著大于非PTE组(P<0.05),但V6导联的QT和QTc在两组之间无显著差异(P>0.05)。PTE组的QTc差值(V1～V6)明显大于非PTE组(P<0.05)。在形态学分析中,PTE组导联Ⅲ中的T波倒置、V1或V1与V2的T波倒置明显高于非PTE组(P<0.05)。两组其他心电图形态学参数包括S1Q3T3的患病率在两组间无显著性差值(P>0.05)。对于预测急性PTE的最大准确性最大QTc差值(V1～V6)≥20 ms,灵敏度为83.2%,特异性及阳性预测值为100%。V1导联T波倒置是与PTE相关的最敏感的形态学异常,敏感性为80.06%,特异性为62.29%,导联Ⅲ中T波倒置是次敏感的预测因子,敏感性为51.20%,特异性为70.53%。结论:QTC差值(V1～V6)是急性PTE的一个明显特征,QTC差值(V1～V6)≥20 ms在急诊环境下可作为鉴别急性PTE的重要指标。
Abstract：Objective: To investigate the diagnostic value of lead corrected Vt and V6 in patients with acute pulmonary thromboembolism.Methods: A total of 89 patients with suspected acute PTE were examined in our hospital from January to December 2017.A baseline 12-lead ECG was recorded on admission, with a gain of 10 mm/mV and a paper velocity of 25 mm/s.Results: Of the 89 suspected PTE patients enrolled in this study, 45 patients with acute PTE and 44 patients without PTE were identified by CTA.The chief complaint of most patients in both groups was dyspnea or dyspnea, with no significant difference between the two groups(P>0.05).The levels of d-dimer and high-sensitivity troponin in patients with PTE were significantly higher than those without PTE(P<0.05).QT and QTc in the V1 lead in the PTE group were significantly greater than those in the non-PTE group(P<0.05), but QT and QTc in the V6 lead were not significantly different between the two groups(P>0.05).The QTc difference(V1-V6) in the PTE group was significantly greater than that in the non-PTE group(P<0.05).In the morphological analysis, T wave inversion in lead Ⅲ of PTE group, T wave inversion of V1 or V1 and V2 was significantly higher than that of non-PTE group(P<0.05).There was no significant difference in the incidence of S1 Q3 T3 between the two groups(P>0.05).For the prediction of acute PTE, the maximum accuracy of the maximum QTc difference(V1-V6) ≥ 20 ms, the sensitivity was 83.2%, and the specificity and positive predictive value was 100%.T-wave inversion in V1 leads is the most sensitive morphological abnormality associated with PTE with a sensitivity of 80.06% and a specificity of 62.29%. T-wave inversion in lead Ⅲ is a sub-sensitive predictor with a sensitivity of 51.20%. The specificity is 70.53%.Conclusions: The QTC difference(V1-V6) is a distinct feature of acute PTE, and QTC difference(V1-V6) ≥20 ms can be used as as an important indicator of acute PTE in emergency settings.
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基本信息:
DOI：10.13210/j.cnki.jhmu.20190304.003
中图分类号:R563.5
引用信息:
[1]孙更新,吴娟.急性肺血栓栓塞症患者V1和V6导联校正QT差异的诊断价值[J].海南医学院学报,2019,25(06):443-446+450.DOI:10.13210/j.cnki.jhmu.20190304.003.
基金信息:
陕西省卫生计划委员会(2017SF-093)~~
2019-03-12
2019-03-12
2019-03-12