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目的比较急性肺动脉栓塞(APE)和非ST段抬高急性冠脉综合征(NSTE-ACS)患者心电图前壁导联负性T波,发现两者的差异,提高心电图(ECG)在两种疾病鉴别诊断中的价值。方法回顾分析首都医科大学附属北京朝阳医院2006年7月至2007年12月住院的33例APE患者和67例NSTE-ACS患者的ECG,比较两组ECG的肺性P波、SⅠSⅡSⅢ、SⅠQⅢTⅢ和前壁导联的负性T波。结果肺性P波、SⅠSⅡSⅢ、SⅠQⅢTⅢ是诊断APE的特异性指标,但是敏感性低。APE患者的负性T波通常出现在Ⅱ、Ⅲ、aVF、V1和V2,较少出现在Ⅰ、aVL和V3～V6(P<0.05)。78.8%的APE患者Ⅲ和V1同时出现负性T波,仅有3%的NSTE-ACS患者Ⅲ和V1同时出现负性T波(P<0.01)。结论可以通过ECG前壁导联的负性T波初步鉴别前壁缺血的NSTE-ACS与APE,Ⅲ和V1导联同时出现负性T波高度提示APE。
Objective To compare the negative T wave of anterior leads of ECG in patients with acute pulmonary embolism (APE) and non-ST segment elevation acute coronary syndrome (NSTE-ACS) and to find the difference between the two and to improve the accuracy of ECG in two kinds of diseases The value of differential diagnosis. Methods The ECG of 33 patients with APE and 67 patients with NSTE-ACS hospitalized from July 2006 to December 2007 in Beijing Chaoyang Hospital Affiliated to Capital University of Medical Science were retrospectively analyzed. The pulmonary P wave, SⅠSⅡSⅢ, SⅠQⅢTⅢ, Wall negative negative T wave. Results Pulmonary P wave, SⅠSⅡSⅢ and SⅠQⅢTⅢ were specific indexes for diagnosis of APE, but their sensitivity was low. Negative T wave of patients with APE usually appear in Ⅱ, Ⅲ, aVF, V1 and V2, but less in Ⅰ, aVL and V3 ~ V6 (P <0.05). Negative T waves were found in Ⅲ and V1 of 78.8% of APE patients, negative T wave of Ⅲ and V1 in only 3% of NSTE-ACS patients (P <0.01). Conclusions The negative T wave of anterior ECG leads can be used to identify the anterior ischemic NSTE-ACS and APE.