心电图与急性肺栓塞

围术期急性肺栓塞（acutepulmonaryembolism，PE）是各种栓子包括血栓、癌栓、脂肪、羊水、空气、手术中使用的双氧水进入静脉循环、堵塞肺动脉系统为发病原因的一组疾病或临床综合征的总称。来自静脉系统或右心的所有堵塞物，堵塞肺动脉或其分支引起的肺循环和呼吸功能障碍的临床和病理综合征，称为肺栓塞症，在围术期仍然以血栓性肺栓塞即指肺血栓栓塞症为主，本文重点介绍了围术期急性肺栓塞的危险因素，那就监测方面我们需要注意些什么引发了我的思考。在全身麻醉状态下，这些患者的自觉症状无法诉说，麻醉常规监测中表现为不明原因的EtCO2下降、血压下降或循环不稳定，连续心电图监测发现急性窦性心动过速，频率在～次／分之间，伴有非特异性ST-T改变。有报道认为，胸前导联T波倒置与大面积急性肺栓塞:急性肺栓塞患者V1、V2导联T波倒置和ST段压低与肺通气血流灌注扫描所显示的缺损肺段的数目显著相关，T波倒置是判断大面积急性肺栓塞最好的预测指标。

EmergencyEvaluationforPulmonaryEmbolism,Part1:ClinicalFactorsthatIncreaseRisk.

KlineJA1,KabrhelC2.

Abstract

BACKGROUND:

Pulmonaryembolism(PE)canbefatal,butprofligatetestingforPEcanharmpatients.

OBJECTIVES:

Withconsiderationofpotentialmedicolegalimplications,thistwo-partreviewprovidescurrentevidenceaboutthecareofpatientswithsuspectedanddiagnosedPEintheemergencydepartment(ED)setting.

DISCUSSION:

Inpart1,wereviewpublishedevidencetodescribetheepidemiology,riskfactors,andclinicalpresentationofPEintheEDsetting.Olderage,surgeryrequiringendotrachealintubationwithinthepast30days,newuseoforalcontraceptives,andpriorunprovokedvenousthromboembolisminnonanticoagulatedpatientsareclearriskfactorsforPEinEDpatients.Recenthistoryofunexplaineddyspnea,pleuriticchestpain,andhemoptysisincreaseprobability,buttheeffectofsyncopeislessclear.Treatedandinactivecancer,smoking,obesity,andpregnancyhavenotbeenfoundtoincreasetheprobabilityofPEinsymptomaticEDpatients.Unexplaineddyspnea,tachycardia,andalowpulseoximetryreadingincreaseprobabilityofPE.FindingofwheezingonlungauscultationreducestheprobabilityofPE,andfindingsthatsuggestdeepvenousthrombosisincreasetheprobabilityofPE.

CONCLUSIONS:

Understandingofriskfactors,historicaldata,andphysicalfindingsthathavebeenfoundtoincreaseordecreasetheprobabilityofPEinsymptomaticEDpatientscanhelpcreaterationalguidelinesforthediagnosticapproachtoPE.

KEYWORDS:

decisionmaking;defensivemedicine;diagnosis;medicolegal;pregnancy;pulmonaryembolism;venousthromboembolism

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