天津医药

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Daniel心电图评分在急性非大面积肺血栓栓塞症早期预后评估中的价值

谷松涛,李月川   

  1. 天津市胸科医院
  • 收稿日期:2012-05-09 修回日期:2012-06-21 出版日期:2012-12-15 发布日期:2012-12-15
  • 通讯作者: 谷松涛

Clinical Significance of Daniel ECG scores for earlier prognosis in acute nonmassive PTE

,yue-chuan LI   

  • Received:2012-05-09 Revised:2012-06-21 Published:2012-12-15 Online:2012-12-15

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摘要： 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）早期预后评估中的临床价值。方法：连续收集2008年1月~2011年9月天津市胸科医院就诊经CT肺动脉造影确诊的急性非大面积PTE患者病例158例，根据心电图评分将患者分为2组：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PTE24小时内完成心电图、动脉血气分析、血B型钠尿肽、血肌钙蛋白I以及超声心动图等检查，随后在治疗开始14天后复查动脉血气分析、超声心动图检查，并观察住院30天重点事件。分析心电图评分与患者右心室功能、呼吸功能以及住院30天内预后的关系。结果： A组与B组在动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、氧合指数、B型钠尿肽（BNP）、肌钙蛋白（TnI）、右室舒张末期内径（RVD）、肺动脉内径（PAD）、三尖瓣反流速度（TR）和肺动脉收缩压（PASP）的差异有统计学意义（P<0.05）；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（P<0.05）；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性和特异性分别为89.8%和85.7%；A组与B组在治疗后（住院30天内）出现低碳酸血症和肺动脉高压（PASP≥50mmHg）的差异有统计学意义（P<0.01）。结论：Daniel心电图评分有助于对急性非大面积PTE患者进行早期预后评估。

关键词: 肺血栓栓塞症, 心电图, 预后

Abstract: Abstract Objective：To explore the clinical significance of Daniel ECG scores for earlier prognosis in acute nonmassive PTE.Methods：A total of 158 patients with acute nonmassive PTE ,confirmed by CTPA,were consecutively recruited from January of 2008 to September of 2011.The 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.They were checked in 24-hour after being confirmed,including ECG,arterial blood gas analysis(ABG),serum markers and echocardiography. The ABG and echocardiography were rechecked after 14-day.Meanwhile,the clinic key things within 30-day in hospital were also checked.The connection of ECG scores,right ventricular function,respiratory function and the prognosis within 30-day in hospital were analysised.Results：There were statistical significant differences in arterial partial pressure of oxygen(PaO2), carbon dioxide(PaCO2),oxygenation index ,B-type natriuretic peptide(BNP),troponin I(TnI),right ventricular end-diastolic diameter(RVD),pulmonary artery inner diameter(PAD),tricuspid regurgitation velocity,and pulmonary artery systolic pressure(PASP) between Group A and B (P<0.05). There were statistical significant differences in sinus tachycardia,QRS axis>90°, SIQIIITIII,V5 lead R/S≤1,avR lead R>0.5mV and T wave inversion in chest lead among several ECG findings between Group A and 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 nonmassive PTE .There were statistical significant differences in the hypocapnia and pulmonary hypertension(PASP≥50mmHg) within 30 days after therapy in hospital between Group A and B(P<0.01). Conclusion： Daniel ECG score is significant for patiens with acute nonmassive PTE to pretest the earlier prognosis.

Key words: Pulmonary thromboembolism, Electrocardiography, Prognosis