心电图基础与临床

1、department of anesthesiology, the first hospital of nanhua university zhigang-zhou department of anesthesiology, the first hospital of nanhua university zhigang-zhou department of anesthesiology, the first hospital of nanhua university zhigang-zhou department of anesthesiology, the first hospital of

2、 nanhua university zhigang-zhou33非不应期非不应期44绝对不应期绝对不应期55总不应期总不应期超常期超常期6612 department of anesthesiology, the first hospital of nanhua university zhigang-zhou0期-qrs波去极化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 university zhigang-zhou department of ane

3、sthesiology, the first hospital of nanhua university zhigang-zhou q r s 波波 department of anesthesiology, the first hospital of nanhua university zhigang-zhou振振幅幅测测量量 department of anesthesiology, the first hospital of nanhua university zhigang-zhou department of anesthesiology, the first hospital of

4、 nanhua university zhigang-zhou峰峰值值测测量量 department of anesthesiology, the first hospital of nanhua university zhigang-zhou department of anesthesiology, the first hospital of nanhua university zhigang-zhou正正 常常 心心 电电 图图 1 department of anesthesiology, the first hospital of nanhua university zhigang-

5、zhou正正 常常 心心 电电 图图 2 department of anesthesiology, the first hospital of nanhua university zhigang-zhou 正常心电图特征及正常值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波开始至qrs波群开始的时间。正常范围为0.120.20s；(

6、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 department of anesthesiology,

7、the first hospital of nanhua university zhigang-zhou department of anesthesiology, the first hospital of nanhua university zhigang-zhou department of anesthesiology, the first hospital of nanhua university zhigang-zhou特点特点: :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 de

8、partment of anesthesiology, the first hospital of nanhua university zhigang-zhou特点特点: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 first hospital of nanhua university zhigang-zhou department of anesthesiology, the first hospital of nanhua university zhigang-zhou左

9、心室肥厚特点左心室肥厚特点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：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

10、病变，应属于正常范围心电图。 department of anesthesiology, the first hospital of nanhua university zhigang-zhou department of anesthesiology, the first hospital of nanhua university zhigang-zhou右心室肥厚特点右心室肥厚特点: :1.qrs1.qrs：rv11.omvrv11.omv；v1v1： r rs sl l； v5v5：r rs1s1.2mv1.2mv ravr0.5mv ravr0.5mv，avravr：rqrq；2.2.

11、心电轴右偏可达心电轴右偏可达+110+110，对诊断右心室肥厚有较大意义；，对诊断右心室肥厚有较大意义；3.v13.v1的室壁激动时间超过的室壁激动时间超过0.03s0.03s，诊断意义较大；，诊断意义较大；4.st-t4.st-t改变；改变；v1v1、v2v2的的stst下降，下降，tv1tv1倒置，有参考价值倒置，有参考价值 department of anesthesiology, the first hospital of nanhua university zhigang-zhou显著电轴右偏显著电轴右偏显著顺钟转位显著顺钟转位v1v1导联导联r/s1r/s1r ravravr0.5

12、mv0.5mvv1v1的室壁激的室壁激动时间动时间0.03s0.03s department of anesthesiology, the first hospital of nanhua university zhigang-zhou department of anesthesiology, the first hospital of nanhua university zhigang-zhou department of anesthesiology, the first hospital of nanhua university zhigang-zhou department of a

13、nesthesiology, the first hospital of nanhua university zhigang-zhou department of anesthesiology, the first hospital of nanhua university zhigang-zhou度度1 1型：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； 度度2 2型：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

14、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 hospital of nanhua university zhigang-zhou完全性房室传导阻滞完全性房室传导阻滞completeheartblock p波与波与qrs波均规律

15、发生，但波均规律发生，但p波与波与qrs波波完全无关，完全无关， 心电图诊断心电图诊断 1.窦性心律不齐窦性心律不齐 2.度房室传导阻滞，室性逸搏心律度房室传导阻滞，室性逸搏心律 department of anesthesiology, the first hospital of nanhua university zhigang-zhou department of anesthesiology, the first hospital of nanhua university zhigang-zhouv1v1呈呈rsrrsr，其余导联终末波，其余导联终末波粗粗qrsqrs时间时间0.120

16、.12秒，为完全性秒，为完全性右束支传导阻滞右束支传导阻滞 department of anesthesiology, the first hospital of nanhua university zhigang-zhou department of anesthesiology, the first hospital of nanhua university zhigang-zhou department of anesthesiology, the first hospital of nanhua university zhigang-zhou department of anesthe

17、siology, the first hospital of nanhua university zhigang-zhou department of anesthesiology, the first hospital of nanhua 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 department of anesthesiology, the first hospital of nanhua university zhigang-zhou锯齿状的锯齿状的f f波一般在波一般在，avfavf导联明显

18、，导联明显，有些时候在有些时候在v1v1导联明显导联明显当心室率在当心室率在150150次次/ /分的时候，应该想到可分的时候，应该想到可能有房扑能有房扑2 2：1 1下传下传 department of anesthesiology, the first hospital of nanhua university zhigang-zhou 博博 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

19、搏动后就有一次室早，称室早二联律 department of anesthesiology, the first hospital of nanhua university zhigang-zhou特点：特点：1.1.急性下壁心梗急性下壁心梗2.2.室早二联律室早二联律 department of anesthesiology, the first hospital of nanhua university zhigang-zhouqrs宽大，形态多变宽大，形态多变r-r间距多变间距多变qrs波看上去像围绕基线扭转波看上去像围绕基线扭转可见于以下情况可见于以下情况心脏传导阻滞心脏传导阻滞低血钾

20、或低血镁低血钾或低血镁药物（如：三环类抗抑郁剂过量）药物（如：三环类抗抑郁剂过量）先天性先天性qt延长综合征延长综合征其他其他qt延长的原因延长的原因尖端扭转性尖端扭转性室性心动过室性心动过速速 department of anesthesiology, the first hospital of nanhua university zhigang-zhou department of anesthesiology, the first hospital of nanhua university zhigang-zhouprpr间期缩短，间期缩短， 0.12s0.12s没有没有波波下侧壁下侧壁

21、st-tst-t改变和左室高电压改变和左室高电压 department of anesthesiology, the first hospital of nanhua university zhigang-zhou心心梗梗acuteinferiormyocardialinfarction department of anesthesiology, the first hospital of nanhua university zhigang-zhou department of anesthesiology, the first hospital of nanhua university zh

22、igang-zhou department of anesthesiology, the first hospital of nanhua university zhigang-zhou1.、avf异常异常q波波:t0.04s,h同导联同导联r波的波的1/4 2. 房颤房颤 department of anesthesiology, the first hospital of nanhua university zhigang-zhou1.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

23、阻滞 室速，室颤 其他洋地黄效应洋地黄效应digitaliseffect department of anesthesiology, the first hospital of nanhua university zhigang-zhou1.t1.t波变小或消失波变小或消失 2.u2.u波增高突出波增高突出3.3.到到度房室传导阻滞度房室传导阻滞 4.st4.st段轻微压低段轻微压低 department of anesthesiology, the first hospital of nanhua university zhigang-zhou1.p波变小或消失 2.房颤3.qrs波增宽 4

24、.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 department of anesthesiology, the first hospital of nanhua university zhigang-zhou心电图心电图:qt:qt间期长达间期长达0.600.60秒，胸前导联秒，胸前导联t t波宽大有波宽大有切迹（可能是切迹（可能是u u波）。波）。长长qtqt综合征易反复出现尖端扭转型室速，晕厥，综合征易反复出现尖端扭转型室速，晕厥，猝死；猝死；通常安装埋藏式复律除颤器（通常安装埋藏式复律除颤器（icdicd）和）和受受体阻滞剂体阻滞剂一起治疗。先天性一起治疗。先天性qtq