中国循证心血管医学杂志2024，Vol.16Issue(12) ：1457-1460.DOI:10.3969/j.issn.1674-4055.2024.12.10

基于急诊心电图分层策略的肺栓塞急诊患者临床评估效能分析

Analysis of the efficacy of clinical assessment of emergency patients with pulmonary embolism based on an emergency ECG stratification strategy

钟玉福 林亚发 林明强 廖旺
中国循证心血管医学杂志2024，Vol.16Issue(12) ：1457-1460.DOI:10.3969/j.issn.1674-4055.2024.12.10
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  • 维普
  • 万方数据

基于急诊心电图分层策略的肺栓塞急诊患者临床评估效能分析

Analysis of the efficacy of clinical assessment of emergency patients with pulmonary embolism based on an emergency ECG stratification strategy

钟玉福 1林亚发 1林明强 2廖旺3
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作者信息

  • 1. 571199 海口,海口市第四人民医院急诊科
  • 2. 570216 海口,海南医学院第二附属医院急诊科
  • 3. 570311 海口,海南省人民医院心血管内科
  • 折叠

摘要

目的 分析急诊心电图(ECG)及Daniel ECG评分在肺栓塞(PTE)急诊患者中的危险分层评估效能.方法 选取2020年3月至2023年3月213例于海口市第四人民医院急诊科确诊的PTE患者,所有患者均行CT肺动脉造影(CTPA)检查并确诊,根据危险分层标准分为高危组(n=40)、中低危组(n=173).分析患者入院48 h内标准的12导联ECG,按照Daniel ECG评分计算得分,对PTE患者进行分层评估.比较两组患者临床资料、Daniel ECG评分及ECG波形改变.绘制ROC曲线评估Daniel ECG评分对高危PTE的预测准确性.结果 高危组4周内有手术/骨折/制动占比、有DVT或PTE病史占比高于中低危组,差异有统计学意义(P<0.05).213例PTE患者中,ECG正常者为30例(14.08％),ECG出现异常者183例(85.92％).其中胸前导联T波倒置最为常见,出现特异性SⅠQⅢTⅢ波形者仅占10.33％.高危组窦性心动过速、TⅢ、SⅠ>1.5 mm、SⅠQⅢTⅢ、V1～V4所有导联倒置>2 mm、TV1倒置>2 mm、TV2倒置>2 mm及TV3倒置>2 mm占比高于中低危组(P<0.05).高危组Daniel ECG评分为(3.47±0.36)分,中低危组为(3.04±0.31)分,差异有统计学意义(P<0.05).ROC曲线结果显示,Daniel ECG评分预测高危PTE敏感性、特异性及AUC分别为57.50％、90.75％、0.746(95％CI:0.682～0.803),(Z=6.106,P<0.001).结论 Daniel ECG评分可较好的预测高危PTE的发生,Daniel ECG评分低于3分时排除高危PTE的价值较高.

Abstract

Objective To analyze the efficacy of emergency electrocardiography (ECG) and Daniel ECG score in assessing risk stratification in emergency patients with pulmonary embolism (PTE).Methods A total of 213 patients with PTE diagnosed in the emergency department of the Fourth People's Hospital of Haikou City from March 2020 to March 2023 were selected,all patients underwent CT pulmonary angiography (CTPA) and were diagnosed.According to the risk stratification standard,they were divided into a high-risk group (n=40) and a middle-low risk group (n=173).The standard 12-lead ECGs within 48h of admission were analyzed,and scores were calculated according to the Daniel ECG score to assess patients with PTE in a stratified manner.The clinical data,Daniel ECG score and ECG waveform changes were compared between groups,and ROC curves were plotted to assess the predictive accuracy of the Daniel ECG score for high-risk PTE.Results The proportion of operation/fracture/immobilization and history of DVT or PTE in the high-risk group were higher than that in the middle-low risk group,and the difference was statistically significant (P＜0.05).Among the 213 PTE patients,30 (14.08％) had normal ECG and 183 (85.92％) had abnormal ECG.Among them,T-wave inversions in the anterior chest leads were the most common,with only 10.33％ showing specific SⅠQⅢTⅢ waveforms.The proportion of sinus tachycardia,TⅢ,SⅠ＞1.5 mm,SⅠQⅢTⅢ,V1-V4 lead inversion＞2 mm,TV1 inversion＞2 mm,TV2 inversion＞2 mm and TV3 inversion＞2 mm in high-risk group was higher than that in middle-low risk group (P＜0.05).The Daniel ECG score was (3.47±0.36) in the high-risk group and (3.04±0.31) in the low-and medium-risk group,with a significant difference between the groups (P＜0.05).The results of the ROC curve showed that the Daniel ECG score predicted high-risk PTE with a sensitivity,specificity and AUC of 57.50％,90.75％,and 0.746 (95％CI:0.682～0.803),respectively (Z=6.106,P＜0.001).Conclusion The Daniel ECG score is a better predictor of high-risk PTE,and the value of excluding the diagnosis of high-risk PTE with a Daniel ECG score below 3 is higher.

关键词

Daniel/ECG评分/心电图/评估效能/危险分层

Key words

Pulmonary embolism/Daniel ECG score/Electrocardiography/Assessment of efficacy/Risk stratification

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出版年

2024
中国循证心血管医学杂志
中国人民解放军北京军区总医院

中国循证心血管医学杂志

CSTPCD
影响因子：1.272
ISSN：1674-4055
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