目的探讨伴有晕厥的大块急性肺栓塞的诊断依据及疗效判定指标。方法对 9例伴有晕厥的大块急性肺栓塞患者的临床特点、心电图、超声心动图变化及预后的临床资料进行回顾性分析。结果 9例患者均有晕厥及极度呼吸困难表现 ,其中 7例有下肢静脉血栓或形成诱因 (下肢外伤 ,卧床数日等 )。 9例中 8例有SⅠQⅢTⅢ 或SⅠTⅢ 、右束支传导阻滞 (RBBB)、显著顺钟向转位 (V5R/S >1)等心动图改变。治疗前 7例行超声心动图检查示 :右心房、室扩大 ,室间隔左移 ,左室小 ,肺动脉高压等超声心动图改变。其中 1例溶栓后随着肺动脉压的降低 ,右心室扩张改善及室间隔左移 ,RBBB、显著顺钟向转位消失 ,SⅠ 减小 ,同时TV1～ 3波呈“冠状T”样倒置加深。结论根据临床表现、心动图、超声心动图改变 ,可及早诊断大块急性肺栓塞 ,后二项对临床疗效判定也有实用价值 Objective To investigate the diagnostic criteria and curative effect of massive pulmonary embolism with syncope. Methods The clinical features, electrocardiogram (ECG), echocardiographic changes and prognosis of 9 patients with massive pulmonary embolism complicated by syncope were analyzed retrospectively. Results All the 9 patients had syncope and extreme dyspnea. Among them, 7 patients had venous thrombosis of lower extremities or inducement of formation (lower extremity trauma, bed rest days, etc. Of the 9 cases, 8 cases had SICQT or STIT, RBBB and V5R / S> 1. Seven cases before treatment echocardiography showed: right atrium, enlarged, left ventricular septum, left ventricular small, pulmonary hypertension and other echocardiographic changes. Among them, one case of thrombolysis with pulmonary artery pressure decreased, right ventricular dilation and left ventricular septal deviation, RBBB significant clockwise shift disappeared, S Ⅰ decreased, while TV1 ~ 3 wave was “coronary T” inverted deepening . Conclusion According to the clinical manifestations, cardiogram, echocardiography changes, early diagnosis of massive acute pulmonary embolism, the latter two of the clinical efficacy of judgments also have practical value