Povezanost različitih elektrokardiografskih znakova sa šok indeksom, veličinom i sistolnim pritiskom desne komore i skorom embolijskog opterećenja kod akutne plućne tromboembolije

  • Bojana Krća Military Medical Academy Medical Faculty, University of Defence, Belgrade
  • Boris Džudović Clinic of Emergency Medicine, Military Medical Academy, Belgrade, Serbia
  • Snježana Vukotić Clinic of Emergency Medicine, Military Medical Academy, Belgrade, Serbia
  • Nenad Ratković Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia; Clinic of Emergency Medicine, Military Medical Academy, Belgrade, Serbia
  • Bojana Subotić Clinic of Emergency Medicine, Military Medical Academy, Belgrade, Serbia
  • Danijela Vraneš Clinic of Emergency Medicine, Military Medical Academy, Belgrade, Serbia
  • Siniša Rusović Institute of Radiology, Military Medical Academy, Belgrade, Serbia
  • Slobodan Obradović Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia; Clinic of Emergency Medicine, Military Medical Academy, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP150512011K
Ključne reči: pulmonary embolism||, ||pluća, embolija, electrocardiography||, ||elektrokardiografija, diagnosis, differential||, ||dijagnoza, diferencijalna, tomography||, ||tomografija, angiography||, ||angiografija, ventricular function, right||, ||srce, funkcija desne komore, sensitivity and specificity||, ||osetljivost i specifičnost,

Sažetak


Uvod/Cilj. Pojava pojedinih elektrokardiografskih (EKG) znakova karakteristična je za akutnu plućnu tromboemboliju (APTE). U ovu grupu znakova spadaju kompletan ili nekompletan blok desne grane (BDG), prisustvo S-zupca u aVL odvodu, S1Q3T3 znak i prisustvo negativnih T-talasa u prekordijalnim odvodima. Tačno značenje pojave ovih znakova i njihova povezanost sa kliničkim stanjem, ehokardiografskim i angiografskim karakteristikama još uvek nisu utvrđeni. Cilj ove studije bio je da se utvrdi povezanost karakterističnih EKG obrazaca na prijemu kod bolesnika sa APTE sa šok indeksom (ŠI), srednjim pritiskom i prečnikom desne komore (SPDK i DDK) i skorom embolijskog opterećenja (embolic burden score, EBS). Metode. Prisustvo BDG, S-zupca u aVL odvodu, S1Q3T3 znaka i negativnih T-talasa u prekordijalnim odvodima zabeleženi su kod 130 bolesnika na prijemu u jedinicu intenzivne nege jedne tercijarne zdravstvene ustanove tokom pet godina. Ehokardiografsko ispitivanje sa merenjem SPDK i DDK, multidetektorska kompjuterizovana tomografska plućna angiografija (MDKT-PA) sa izračunavanjem EBS i utvrđivanje ŠI vršeni su tokom prijemne obrade bolesnika. Multivarijabilni regresioni modeli utvrđeni su na osnovu pomenutih EKG znakova kao nezavisnih promenljivih i ŠI, SPDK, DDK i EBS kao zavisnih promenljivih varijabli. Rezultati. Prisustvo S-zupca u aVL odvodu jedini je nezavisni prediktor visine SPDK (F = 29,903, p < 0,001; usklađen R2 = 0,185) i veličine DDK (F = 39,430, p < 0,001; usklađen R2 = 0.231). Negativni T-talasi u prekordijalnim odvodima jedini su nezavisni prediktori veličine EBS (F = 24,177, p < 0,001; usklađeni R2 = 0,160). Jedini nezavisan prediktor veličine ŠI je BDG (F = 20,980, p < 0,001; usklađeni R2 = 0,134). Zaključak. Kod bolesnika sa APTE karakteristični EKG obrasci povezani su sa kliničkim, ehokardiografskim i angiografskim statusom. Pojava BDG ukazuje na veći ŠI, a shodno tome na težu kliničku sliku. Prisutan S-zubac u aVL odvodu u vezi je sa visinom SPDK i veličinom DDK, pa se njegova pojava može shvatiti kao preteća disfunkcija desne komore. Prisustvo negativnih T-talasa u prekordijalnim odvodima ukazuje na veći EBS, samim tim, na zahvaćenost velikih krvnih sudova plućnog vaskularnog korita trombnim masama.

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Objavljeno
2017/03/08
Broj časopisa
Vol. 73 Br. 10 (2016)
Rubrika
Originalni članak