Research Of The Value Of Electrocardiogram, Echocardiography, Lower Limbs Deep Venous Ultrasound In Diagnosing Acute Pulmonary Thromboembolism

Objective To analyze the abnormal characteristics of electrocardiogram, echocardiography,lower limbs deep venous ultrasound, D-dimer, and arterial blood gas analysis in acutepulmonary thromboembolism (APTE), to evaluate the clinical value of electrocardiogram,echocardiography, lower limbs deep venous ultrasound, D-dimer, and arterial blood gasanalysis in diagnosing APTE.Methods A retrospective analysis was made in594patients with suspected APTE andconfirmed APTE from January2002to December2012in the General Hospital of NingxiaMedical University.The general clinical data was analyzed, including gender, age, medicalhistory, symptoms, signs, D-dimer testing, arterial blood gas analysis, ECG, echocardiography,lower limbs deep venous ultrasound. The analysis Focus on the abnormal characteristics ofelectrocardiogram, echocardiography, lower limbs deep venous ultrasound, D-dimer, arterialblood gas analysis in patients with APTE. All diagnosis in them were confirmed CTpulmonary angiography (CTPA) and radionuclide lung ventilation/perfusion scan，which isfor “gold standard” to diagnose APTE. The clinical diagnostic value of electrocardiogram,echocardiography, lower limbs deep venous ultrasound, D-dimer, arterial blood gas analysiswas evaluated by the common parameters of diagnostic test.Results465cases (78.28%) were confirmed APTE,129cases (21.72%) were excludedAPTE. In confirmed groupe,there were chest tightnes246(53.25%), shortness of breath347(75.32%), dyspnea45(9.87%), chest pain187(40.52%), hemoptysis or bloody sputum(12.47%), cough and expectoration140cases (30.39%), syncope26(5.71%), chest pain, dyspnea, hemoptysis triad4(0.78%). The sensitivity, specificity, positive predictive value,negative predictive value, positive likelihood ratio, and negative likelihood ratios ofelectrocardiogram for the diagnosis of APTE were34.92%,86.05%,89.94%,73.25%,2.5,and0.75,respectively. The sensitivity, specificity, positive predictive value, negativepredictive value, positive likelihood ratio,and negative likelihood ratios of echocardiographyfor the diagnosis of APTE were58.5%,65.11%,85.8%,30.32%,1.68,and0.64,respectively.The specificity, positive predictive value, negative predictive value, positive likelihood ratio,and negative likelihood ratios of lower limbs venous ultrasound for the diagnosis of APTEwere64.73%,67.44%,87.76%,34.66%,1.08,and0.52,respectively. The sensitivity, specificity,positive predictive value, negative predictive value, positive likelihood ratio, and negativelikelihood ratios of D-dimer for the diagnosis of APTE were64.3%,45.74%,81.03%,26.22%,1.19,and0.78,respectively. The sensitivity, specificity, positive predictive value, negativepredictive value, positive likelihood ratio, and negative likelihood ratios of arterial blood gasanalysis for the diagnosis of APTE were40.43%,62.80%,79.66%,77.37%,1.09,0.95,and0.03,respectively.Conclusions1. The electrocardiographic changes in patients with APTE are significanttiming characteristics,which has a certain clinical diagnosis and differential diagnosissignificance.Early detection of electrocardiogram is an important tool for the diagnosis ofAPTE, especially in primary health care institutions.2.APTE was confirmed if direct signs ofthromboembolism were found by color Doppler echocardiography.If indirect signs ofthromboembolism,such as right ventricular overload,pulmonary hypertension,were found bycolor Doppler echocardiography,which prompt the diagnosis of APTE.Thus,color Dopplerechocardiography for the diagnosis of APTE has important clinical value.3. Lower limbsvenous ultrasound may clear source of pulmonary thromboembolism and select treatmentstrategies.4.Combined electrocardiogram,echocardiography, lower limbs deep venousultrasound, plasma D-dimer with arterial blood gas analysis has a very important clinical value in the diagnosis of acute pulmonary thromboembolism，which helps clinicians toquickly establish or exclude APTE.