心电图基础与临床.ppt

《心电图基础与临床.ppt》由会员分享，可在线阅读，更多相关《心电图基础与临床.ppt（55页珍藏版）》请在三一办公上搜索。

1、Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,心电图,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,心 电 图 的 产 生,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,心电通路,Department of Anesthesiology,The

2、First Hospital of NanHua University ZhiGang-ZHOU,3,3,非不应期,4,4,绝对不应期,5,5,总不应期,超常期,6,6,1,2,AP与ECG1,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,0期-QRS波去极化,AP与ECG2,0期,2期,1期,3期,4期,1期-J点,2期-ST断,3期-T波,4期-等电位线,Department of Anesthesiology,The First Hospital of NanHua Un

3、iversity ZhiGang-ZHOU,常规心电图的波形组成和测量示意图,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,Q R S 波,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,振幅测量,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,时间

4、测量,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,峰值测量,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,电轴测量?,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,正 常 心 电 图 1,Department of Anesthesiology

5、,The First Hospital of NanHua University ZhiGang-ZHOU,正 常 心 电 图 2,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,正常心电图特征及正常值(1)心电图纸：小方格=0.04s(横)0.lmV(纵)；(2)心率：正常为60100bpm之间；(3)心律：窦性心律（、aVF、V4-6直立，aVR为倒置）(4)P波：、aVF、V4-6直立，aVR为倒置；T0.11S；电压：肢导0.25mV，胸导0.2mV；(5)P-R间期：P

6、波开始至QRS波群开始的时间。正常范围为0.120.20s；(6)QRS波群：时间：0.060.10s；(7)ST段：自J点开始至T波开始的一段。sT段平行的压低或斜向下的压低不正常，轻度抬高可见于正常人；(8)T波；aVR导联倒置，余在R波高于0.5mV时均应直立；(9)U波：V2-3中易见，正常应直立；(10)Q-T间期：QRS波开始至T波终了的间期，Q-T间期与心率不符合的延长有较重要意义。异常缩短多为药物或电解质紊乱影响。,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,

7、窦性心律失常,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,窦性心动过速 Sinustachycardia,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,窦性心动过缓Sinusbradychycardia,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZH

8、OU,特点:1Pvl负向波0.04s，深1.0mm。2.P时间常超过O.11s。3.P出现双峰，峰距常超过0.04s。4P波宽度与P-R段之比超过1.6,左房扩大leftatrialenlargement,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,右房扩大RightAtrialEnlargement,特点:l.P波时间不延长2.Pv1高达0.15mv或P高达0.25mv3.本图除右房大外，还有电轴右偏,Department of Anesthesiology,The Fir

9、st Hospital of NanHua University ZhiGang-ZHOU,左心室肥厚 leftatrialhypertrophy,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,左心室肥厚特点1、QRs波群电压的改变：A.肢导：R15mV，R+S25mV；Ravl0.7，Ravf2.0mvB.胸导:Rv5+Sv13.5mV(女)，4.0mV(男)；R5/R6+Sv1Sv34.Omv2、心电轴：+030度属电轴左偏，电轴左偏对诊断只有参考价值；3、QRS时间延长：

10、可延长0.09s，但不超过0.11s；4、ST-T波改变：以R波为主的导联ST段下降超过0.05mv，T波倒置，属不正常；原因：继发性或原发性；5、目前认为电压增高加以STT改变，诊断左心室肥厚最为准确；仅有ST改变者为左心室“劳损”,劳损的改变有时呈可逆的；仅有电压升高不能属于器质性病变，应属于正常范围心电图。,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,右心室肥厚RightVentricularHypertrophy,Department of Anesthesiolog

11、y,The First Hospital of NanHua University ZhiGang-ZHOU,右心室肥厚特点:1.QRS：Rv11.OmV；v1：RSl；V5：RS1.2mV RavR0.5mv，avR：RQ；2.心电轴右偏可达+110，对诊断右心室肥厚有较大意义；3.V1的室壁激动时间超过0.03s，诊断意义较大；4.ST-T改变；V1、V2的ST下降，Tv1倒置，有参考价值,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,双 侧 心 室 肥 厚,显著电轴右偏显

12、著顺钟转位V1导联R/S1RavR0.5mvV1的室壁激动时间0.03s,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,双侧心室肥厚,近似正常心电图,出现一侧肥厚心电图改变,出现两侧肥厚心电图特征,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,房 室传 导阻 滞,Department of Anesthesiology,The First Hospital of

13、 NanHua University ZhiGang-ZHOU,一度房室传导阻滞firstdegreeheartblock,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,2：1房室传导阻滞 2to1AVblock,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,度1型：P-R间期逐渐延长，直至P波落在房室结区的绝对不应期时，出现一次完全阻滞；可见于健康人，也可因迷

14、走神经刺激如颈动脉窦受压、洋地黄中毒等所引起，多为暂时性，无需特殊治疗；度2型：系希氏束浦顷野纤维传导系统病变所致，PR间期正常或延长，部分P波后无QRS波，房室阻滞比例多为2:1或3:1。型预后严重，多数存在房室结、房室束纤维化病变或损害，且有演变为度AVB的危险，药物治疗或需安置起搏器治疗；单纯2度，无血流动力学紊乱情况，只要做好维护血流动力学稳定、无缺氧CO2蓄积、输液输血合理即可。术中伴有血流动力学显著波动（如血压下降，心率增快、缺氧、CO2蓄积等），则很可能转为3度AVB，必须有置入起搏器的准备,Department of Anesthesiology,The First Hospi

15、tal of NanHua University ZhiGang-ZHOU,完全性房室传导阻滞CompleteHeartBlock,P波与QRS波均规律发生，但P波与qrs波完全无关，心电图诊断 1.窦性心律不齐 2.度房室传导阻滞，室性逸搏心律,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,完全性房室传导阻滞伴心房纤颤trialfibrillationandcompleteheartblock,Department of Anesthesiology,The First Ho

16、spital of NanHua University ZhiGang-ZHOU,右束支传导阻滞RightBundleBranchBlock,V1呈rsR，其余导联终末波粗qrs时间0.12秒，为完全性右束支传导阻滞,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,房性早搏AtrialPrematureBeat,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,房性早

17、搏二联律AtrialBigeminy,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,房 颤 的 形 成,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,心房纤颤伴左束支阻滞Atrialfibrillationwithpre-existingLBBB,Department of Anesthesiology,The First Hospital of NanHua

18、University ZhiGang-ZHOU,锯齿状规则的F波，频率300次/分左右患者因服用地高辛过量导致房室传导阻滞，心室律缓慢,心房扑 动 AtrialFlutter,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,锯齿状的F波一般在，AVF导联明显，有些时候在V1导联明显当心室率在150次/分的时候，应该想到可能有房扑2：1下传,心房扑动2：1传导Atrialflutterwith2:1AVconduction,Department of Anesthesiology,

19、The First Hospital of NanHua University ZhiGang-ZHOU,交界性早博,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,特点:提前的宽大畸形的QRS波，T0.12S，其前无相关P波，代偿间歇一般完全一次正常搏动后就有一次室早，称室早二联律,室早Ventricularprematurebeats,Department of Anesthesiology,The First Hospital of NanHua University Zh

20、iGang-ZHOU,特点：1.急性下壁心梗2.室早二联律,急性心梗伴室早,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,特点:QRS宽大，形态多变 R-R间距多变QRS波看上去像围绕基线扭转可见于以下情况 心脏传导阻滞 低血钾或低血镁 药物（如：三环类抗抑郁剂过量）先天性QT延长综合征 其他QT延长的原因,尖端扭转性室性心动过速,Department of Anesthesiology,The First Hospital of NanHua University ZhiGa

21、ng-ZHOU,W-P-W综合症 Wolff-Parkinson-Whitesyndrome,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,PR间期缩短，0.12s没有波下侧壁ST-T改变和左室高电压,L-G-L综合症 Lown-Ganong-LevineSyndrome,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,急性下壁心梗Acuteinferiormyo

22、cardialinfarction,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,急性前壁心梗Acuteanteriormyocardialinfarction,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,下壁前壁心肌梗塞并左束支阻滞,Department of Anesthesiology,The First Hospital of NanHua Unive

23、rsity ZhiGang-ZHOU,1.、AVF异常Q波:T0.04S,H同导联R波的1/4 2.房颤,陈旧下壁心梗,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,1.QT间期缩短2.特征性ST-T改变：ST-T融合呈鱼钩样改变(V5,V6）3.节律异常（一般见于洋地黄中毒）室性或房性早搏 阵发性房速及不同程度的房室传导阻滞 室速，室颤 其他,洋地黄效应Digitaliseffect,Department of Anesthesiology,The First Hospita

24、l of NanHua University ZhiGang-ZHOU,低钾血症 Hypokalaemia,1.T波变小或消失 2.U波增高突出3.到度房室传导阻滞 4.ST段轻微压低,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,1.P波变小或消失 2.房颤3.QRS波增宽 4.ST段变短或消失5.T波基底部变窄，T波高尖呈帐篷状6.室颤,高钾血症Hyperkalaemia,Department of Anesthesiology,The First Hospital of

25、NanHua University ZhiGang-ZHOU,心电图:QT间期长达0.60秒，胸前导联T波宽大有切迹（可能是U波）。长QT综合征易反复出现尖端扭转型室速，晕厥，猝死；通常安装埋藏式复律除颤器（ICD）和受体阻滞剂一起治疗。先天性QT延长综合征发病机理与许多不同的“通道病”有关,先天性QT间期延长综合征LongQTsyndrome,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,急性心包炎Pericarditis,Department of Anesthesiolo

26、gy,The First Hospital of NanHua University ZhiGang-ZHOU,急性心包炎ST段抬高，应考虑以下原因：1.缺血性心脏病（MI，变异型心绞痛，室壁瘤）2.心包炎 3.左束支传导阻滞（v1v3或v4）4.正常的变异（J点抬高，过早复极综合征）这份图中两点支持心包炎：1.除AVR导联外，ST段广泛抬高；心梗抬高一般有定位性（下壁，前壁，后壁，侧壁导联）且常伴对应导联的ST段压低。2.PR段移位，原因可能是心包炎时心外膜心房肌损伤，图中表现为AVR导联PR段压低，AVF,V4-V6导联PR段抬高,Department of Anesthesiology,The First Hospital of NanHua University ZhiGang-ZHOU,1.出项钉样起搏信号（在v4v6较清楚）2.起搏的QRS波宽大畸形,心室起搏Ventricularpacemaker,