心电图基础及围手术期常见心律失常的处理.ppt

血清钾5.5—6.0mmol/L，导致电位3相时间缩短，坡度陡峻，心电图T波高耸，QT间期缩短。 高钾血症 血清钾6.0—7.0mmol/L，心肌细胞静期膜电位上移， 0相上升速度减慢，心电图上表现为QRS增宽，呈不定型心室内阻滞图形。 高钾血症 血清钾7.0—7.5mmol/L，心房肌受到抑制，P波振幅减小，QRS增宽更明显。 高钾血症 血清钾大于8.0mmol/L，心房肌被抑制，窦房结的起搏功能尚存在，此时的窦性激动经过结间束达到房室结进入心室，心电图上P波虽消失，但QRS波群规则出现，此时称为窦室传导节律。 高钾血症 高钾血症 减少K的来源 10%葡萄糖酸钙 5%碳酸氢钠 呋塞米 聚苯乙烯磺酸钠交换树脂 血液透析 低钾血症 减少K的流失 补钾：口服，经静脉 血钾异常的处理 外科围手术期可发生各种心电异常 各种心律失常以窦速、房颤及房扑多见 主要措施：减少和预防心肌缺血，改善心功能，维持电解质和代谢平衡 第一原则：维持血流动力学稳定 结语 EKG An EKG records the electrical activity within the heart via electrodes placed at certain points on the patient’s skin. The electrodes, which can be disks, metal plates, or suction cups are attached to the EKG machine by cables. * * An ECG is recorded on ruled graph paper. ? The horizontal axis measures the duration of a waveform in milliseconds (ms). Each small square is 40 ms when recorded at a display speed of 25 mm/sec. Each large square is 200 ms (5 x 40 ms). Note that heavier lines mark off the larger squares. ? The vertical axis measures the amplitude (voltage) of a waveform in millimeters (mm). On the default scale, each small square is 1 mm and each large square 5 mm (5 x 1 mm). Amplitude refers to the strength of an electrical signal. * 1902荷兰Einthoven发明弦线心电图机，1942年Wilson提出体表导联和加压导联。40年代开始12导ECG * The heart rate can be determined by counting the squares on the ECG graph. To calculate the ventricular rate: ? Count the squares between the peaks of two R-waves. Example: 4 large squares + 1 small square ? Calculate the duration. Example: 800 ms (4 large squares) + 40 ms (1 small square) = 840 ms ? Convert the duration to rate. Example: 60,000 (ms in one minute) / 840 ms = 71 bpm To estimate by counting down: ? Start at the first R-wave. ? Count off each large square until the next R-wave: 300, 150, 100, 75, 60, 50. The estimated rate shown in the example is 75 bpm. Another option is to count the number of small squares and refer to a Rate Conversion chart. * I * * * * * PR逐渐延长，RR逐渐缩短 * * * * * * * * * * I°房室传导阻滞 * PR