心电图基础与临床课件

1、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 First Hospital of NanHua University ZhiGang-ZHOU0期-QRS波去极化AP与ECG20期2期1期3期4期1期-J点2期-

2、ST断3期-T波4期-等电位线Department of Anesthesiology, The First Hospital of NanHua University 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

3、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正 常 心 电 图 1Department 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

4、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)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

5、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窦性心律失常Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU窦性心动过速 SinustachycardiaDepartment of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU 窦

6、性心动过缓SinusbradychycardiaDepartment of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU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leftatrialenlargementDepartment of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU左心室肥厚 leftat

7、rialhypertrophyDepartment 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：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

8、，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

9、；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 厚显著电轴右偏显著顺钟转位V1导联R/S1RavR0.5mvV1的室壁激动时间0.03sDepartment of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU房 室传 导阻 滞Department of Anesthesiology, The First H

10、ospital of NanHua University ZhiGang-ZHOU一度房室传导阻滞firstdegreeheartblockDepartment of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU 2：1房室传导阻滞 2to1AVblockDepartment of Anesthesiology, The First Hospital 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

11、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trialfibrillationandcompleteheartblockDepartment of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU右束支传导阻滞RightBundleBranchBlockV1呈rsR，其余导联终

12、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AtrialPrematureBeatDepartment of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU房性早搏二联律AtrialBigeminyDepartment of Anesthesiology, The First Hospital of NanHua Universi

13、ty 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-existingLBBBDepartment 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，心室律缓慢心房扑 动 AtrialFlutterD

14、epartment 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Atrialflutterwith2:1AVconductionDepartment of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU 交界性早博Department of Anesthesiology, Th

15、e 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VentricularprematurebeatsDepartment of Anesthesiology, The First Hospital of NanHua University ZhiGang-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 NanHu

16、a 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 ZhiGang-ZHOUW-P-W综合症 Wolff-Parkinson-WhitesyndromeDepartment of Anesthesiology, The First Hospital o

17、f NanHua University ZhiGang-ZHOUPR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-LevineSyndromeDepartment of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU 急性下壁心梗AcuteinferiormyocardialinfarctionDepartment of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHO

18、U急性前壁心梗AcuteanteriormyocardialinfarctionDepartment 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 University ZhiGang-ZHOU1.、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 Ho

19、spital 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阻滞 室速，室颤 其他洋地黄效应DigitaliseffectDepartment of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU低钾血症 Hypokalaemia1.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 o

20、f 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.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HyperkalaemiaDepartment of Anesthesiology, The First Hospital of 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