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Vojnosanitetski pregled
2016, vol. 73, br. 10, str. 921-926
jezik rada: engleski
vrsta rada: izvorni naučni članak
doi:10.2298/VSP150512011K

Creative Commons License 4.0
Povezanost različitih elektrokardiografskih znakova sa šok indeksom, veličinom i sistolnim pritiskom desne komore i skorom embolijskog opterećenja kod akutne plućne tromboembolije
aFaculty of Medicine of the Military Medical Academy, University of Defence, Belgrade
bClinic of Emergency Medicine, Military Medical Academy, Belgrade
cFaculty of Medicine of the Military Medical Academy, University of Defence, Belgrade + Clinic of Emergency Medicine, Military Medical Academy, Belgrade
dInstitute of Radiology, Military Medical Academy, Belgrade

e-adresa: sloba.d.obradovic@gmail.com

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 scote, 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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