常见异常心电图(修改版).ppt
常见异常心电图,广州军区武汉总医院,wuhan general hospital,guangzhou command,2,Content,心电图形成机制心电图导联正常心电图常见异常心电图紧急处理,心电图形成机制,广州军区武汉总医院,wuhan general hospital,guangzhou command,3,广州军区武汉总医院,wuhan general hospital,guangzhou command,4,窦性频率：60-100bpm交界区：40-60bpm室性：20-40bpm,心脏传导系统,广州军区武汉总医院,wuhan general hospital,guangzhou command,5,心电图形成机制,广州军区武汉总医院,wuhan general hospital,guangzhou command,6,心电图形成机制,广州军区武汉总医院,wuhan general hospital,guangzhou command,7,心电图导联,广州军区武汉总医院,wuhan general hospital,guangzhou command,8,心电图导联,广州军区武汉总医院,wuhan general hospital,guangzhou command,9,心电图导联,广州军区武汉总医院,wuhan general hospital,guangzhou command,10,心电图导联,广州军区武汉总医院,wuhan general hospital,guangzhou command,11,正常心电图,广州军区武汉总医院,wuhan general hospital,guangzhou command,12,1.窦性心律：P波II导联直立，AVR导联倒置。2.心率60-100bpm，无波形、波幅、节律等的异常。,正常心电图,广州军区武汉总医院,wuhan general hospital,guangzhou command,13,1.窦性心律：P波II导联直立，AVR导联倒置。2.心率60-100bpm，无波形、波幅、节律等的异常。,左心房肥大,广州军区武汉总医院,wuhan general hospital,guangzhou command,14,P波增宽0.11s，常呈双峰型，双峰间期0.04s，典型者多见于二尖瓣狭窄，故称为“二尖瓣型P波”。,右心房肥大,广州军区武汉总医院,wuhan general hospital,guangzhou command,15,P波尖而高耸，其振幅0.25mV，在II、III、aVF导联表现最突出，称为“肺型P波”。,左心室肥大,广州军区武汉总医院,wuhan general hospital,guangzhou command,16,1.RV52.5mV；RV5+SV14.0mV（男性）或3.5mV（女性）。2.导联的波1.5mV，aVL的波1.2mV。3.往往并存ST-T继发改变（肥大伴劳损）。,右心室肥大,广州军区武汉总医院,wuhan general hospital,guangzhou command,17,广州军区武汉总医院,wuhan general hospital,guangzhou command,18,心肌缺血,ST段水平或下斜型压低0.1mv、持续时间大于1min，通常在运动、情绪激动等诱因下发作。,广州军区武汉总医院,wuhan general hospital,guangzhou command,19,心肌梗死,窦性心律失常：过慢,广州军区武汉总医院,wuhan general hospital,guangzhou command,20,窦性心律失常：过快,广州军区武汉总医院,wuhan general hospital,guangzhou command,21,窦性心律失常：不齐,广州军区武汉总医院,wuhan general hospital,guangzhou command,22,窦性心律失常：不齐,广州军区武汉总医院,wuhan general hospital,guangzhou command,23,房室传导阻滞：度,广州军区武汉总医院,wuhan general hospital,guangzhou command,24,房室传导阻滞：度,广州军区武汉总医院,wuhan general hospital,guangzhou command,25,房室传导阻滞：度,广州军区武汉总医院,wuhan general hospital,guangzhou command,26,游走型心律,广州军区武汉总医院,wuhan general hospital,guangzhou command,27,房性心律失常：房速,广州军区武汉总医院,wuhan general hospital,guangzhou command,28,可见房性“P”波，心率150bpm,房性心律失常：房扑,广州军区武汉总医院,wuhan general hospital,guangzhou command,29,1.锯齿波：F波2.心律整或不整,房性心律失常：房颤,广州军区武汉总医院,wuhan general hospital,guangzhou command,30,f波节律绝对不整。QRS波为室上性。,交界性心律,广州军区武汉总医院,wuhan general hospital,guangzhou command,31,交界性心律失常：交界性心动过速,广州军区武汉总医院,wuhan general hospital,guangzhou command,32,频率150-250bpm、节律规整，通常可被早搏触发和终止，发生机制是房室结或房室折返。,交界性心律失常：交界性传导阻滞,广州军区武汉总医院,wuhan general hospital,guangzhou command,33,正常PR间期：0.12-0.20sPR间期0.24s，提示房室交界区传导异常。,室性心律失常：早搏,广州军区武汉总医院,wuhan general hospital,guangzhou command,34,1.提前出现的QRS波，且宽大畸形。2.P波消失。3.代偿间歇多完整。,室性心律失常：室性心动过速,广州军区武汉总医院,wuhan general hospital,guangzhou command,35,宽大畸形QRS波，130-300bpm，节律多规整。,室性心律失常：室颤,广州军区武汉总医院,wuhan general hospital,guangzhou command,36,完全不规则颤动波，见不到规整的QRS波心跳停止。,起搏性心律,广州军区武汉总医院,wuhan general hospital,guangzhou command,37,1.QRS波宽大畸形。2.P波消失。3.节律规整。,紧急处理,广州军区武汉总医院,wuhan general hospital,guangzhou command,38,观察意识，症状，体征，有无阿-斯综合征。评估血流动力学，主要是血压。报告医生。遵医嘱紧急用药心动过缓或传导阻滞：阿托品或肾上腺素。快速性室上性心动过速，西地兰。室性心律失常：利多卡因，胺碘酮。室颤或心电静止：捶击，CPR,电复律。,Thank you for you concerns!,广州军区武汉总医院,wuhan general hospital,guangzhou command,39,
