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心电图学习笔记:临床实战I偶遇一例肺栓塞心电图

  • 2026-05-11 22:53:59
心电图学习笔记:临床实战I偶遇一例肺栓塞心电图
临床工作中，急性肺栓塞向来是“隐匿的杀手”，症状不典型，漏诊误诊率高，而心电图作为最便捷的检查，是我们筛查、鉴别急性肺栓塞的第一道防线。
今日上班，刚好碰到一例疑似肺栓塞的心电图改变，结合这份病例整理了有关肺栓塞的心电图改变知识点！
先看病例
患者，男性，70岁，因皮肤挫伤，收治创伤骨科住院
2026.5.9号 心电图如下 诊断：窦性心律，侧壁T波改变，患者心超、胸部X片基本正常。
2026.5.11 心电图显示如下，心电图发生了动态改变，对比9号心电图新出现了窦性心动过速，完全性右束支阻滞，ST-T改变，（现在各医院开展心电一张网后，远程心电的短板是看不到病人，不能结合病史、实验室检查结果，仅仅上传一张图），心电图不能确诊急性肺栓塞，但针对这份心电图得高度怀疑。最后肺动脉CT：左右肺动脉主干及两肺分支多发栓塞 确诊该患者急性肺栓塞！
很多时候，急性肺栓塞心电图没有特异性和诊断性，但组合式的图形改变+临床高危因素，足以让我们快速锁定嫌疑，避免漏诊！
核心牢记：急性肺栓塞的典型心电图改变
肺栓塞的本质是右心负荷急剧增加，心电图所有改变均围绕“右心受累”展开
1.黄金特征：SIQIIITIII， 注意：该征并非100%出现，发生率约15%-25%，多为一过性，还可以出现多种形式不典型组合，如SIQIII、SITIII、QIIITIII ，新近出现有临床意义。
2.高频常见改变
  •  窦性心动过速：最常见的心律失常表现，为机体代偿反应。
  •  右束支阻滞：完全性/不完全性均可见，提示右心负荷过重
  • ST-T改变：胸导联T波倒置是心电图最早期的改变，一般自右向左逐渐   变浅，ST-T改变反映急性心肌缺血，尤其是右室心肌缺血。此外由于肺栓塞，肺血管内皮受损，释放大量血管活性物质易可加重心肌缺血，造成类似冠脉缺血性ST-T改变。
  • 其他右心负荷过重心电图改变：电轴右偏、顺钟向转位、肺型P波，aVR导联出现终末R波病科伴ST段抬高（类似左主干闭塞的心电图ST-T改变）
结语：肺栓塞凶险且隐匿，心电图虽无绝对特异性，却是临床最易获取、最快捷的筛查工具，遇到不明原因胸闷、心悸的患者，多一份警惕。多留意心电图上的“蛛丝马迹”，就能为患者争取更多的救治时间。
申明：以上内容均为临床实践中碰到典型案例，再结合知识点整理，仅供个人学习、参考用，有错误请指正，转载请留言！
本文来自网友投稿或网络内容，如有侵犯您的权益请联系我们删除，联系邮箱：wyl860211@qq.com 。

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  134. /yingpanguazai/ssd/ssd1/www/no.67808.cn/vendor/topthink/think-view/src/Think.php ( 8.38 KB )
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  1. CONNECT:[ UseTime:0.000823s ] mysql:host=127.0.0.1;port=3306;dbname=no_67808;charset=utf8mb4
  2. SHOW FULL COLUMNS FROM `fenlei` [ RunTime:0.001586s ]
  3. SELECT * FROM `fenlei` WHERE `fid` = 0 [ RunTime:0.007958s ]
  4. SELECT * FROM `fenlei` WHERE `fid` = 63 [ RunTime:0.001309s ]
  5. SHOW FULL COLUMNS FROM `set` [ RunTime:0.001423s ]
  6. SELECT * FROM `set` [ RunTime:0.006285s ]
  7. SHOW FULL COLUMNS FROM `article` [ RunTime:0.001646s ]
  8. SELECT * FROM `article` WHERE `id` = 487891 LIMIT 1 [ RunTime:0.011019s ]
  9. UPDATE `article` SET `lasttime` = 1778614660 WHERE `id` = 487891 [ RunTime:0.013130s ]
  10. SELECT * FROM `fenlei` WHERE `id` = 65 LIMIT 1 [ RunTime:0.000709s ]
  11. SELECT * FROM `article` WHERE `id` < 487891 ORDER BY `id` DESC LIMIT 1 [ RunTime:0.001305s ]
  12. SELECT * FROM `article` WHERE `id` > 487891 ORDER BY `id` ASC LIMIT 1 [ RunTime:0.003611s ]
  13. SELECT * FROM `article` WHERE `id` < 487891 ORDER BY `id` DESC LIMIT 10 [ RunTime:0.020214s ]
  14. SELECT * FROM `article` WHERE `id` < 487891 ORDER BY `id` DESC LIMIT 10,10 [ RunTime:0.006268s ]
  15. SELECT * FROM `article` WHERE `id` < 487891 ORDER BY `id` DESC LIMIT 20,10 [ RunTime:0.021915s ]
0.185996s