第四篇器械檢查第一章心電圖（ELECTROCARDIOGRAM）呂卓人第一節(jié)臨床心電學(xué)的基本知識第二節(jié)心電圖的測量和正常值1了解心電圖產(chǎn)生的原理2熟悉常用導(dǎo)聯(lián)、正常心電圖各波的圖像、正常參考值3熟悉有關(guān)心電圖診斷的常用英語詞匯QUESTIONSWHYECGCOULDBESERVEDFORTHEDIAGNOSISOFSOMEDISEASESHOWDOESECGWORKWHATISECGWHATISNORMALECGAREALCASEWITHCHESTPAINDIAGNOSISABASICKNOWLEDGEOFECG1DEPOLARIZATIONANDREPOLARIZATIONSINGLEMYOCARDIALCELLAMUSCLESTRIP2VECTORANDRESULTANTVECTOR3PACINGANDCONDUCTINGSYSTEMOFTHEHEARTSINUSNODEINTERNODALTRACTSAVNODERIGHTBUNDLEBRANCHRBBPURKINJEFIBERSBUNDLEOFHISANTERIORFASCICLELEFTBUNDLEBRANCHLBBPURKINJEFIBERSPOSTERIORFASCICLE4LEADSYSTEMLIMBLEADSSTANDARDLEADSI,II,IIILIMBLEADSAVR,AVL,AVFHEXAXIALSYSTEMCHESTLEADSV1,V2,V3,V4,V5,V6,V7,V8,V9BNORMALECGPWAVEPRINTERVALQRSCOMPLEXSTSEGMENTTWAVEQTINTERVALUWAVE1MEASUREMENTOFECGWAVESANDINTERVALSECGPAPERMEASURINGHEARTRATEHR60/RRBPMREGULARORIRREGULARRHYTHMAMPLITUDEOFWAVESORSEGMENTP,QRS,ST,T,UWIDTHORDURATIONOFWAVESP,QRS,T,UDURATIONOFINTERVALSPR,QTSHAPEOFWAVESP,QRS,T2MEANQRSAXISLNORMALCARDIACAXISRANGEFROM3090LSIGNIFICANTLEFTDEVIATION3090LRIGHTDEVIATION90180LSIGNIFICANTRIGHTDEVIATION180903CLOCKWISEANDCOUNTERCLOCKWISEROTATIONLCLOCKWISEROTATIONCOUNTERCLOCKWISEROTATION4NORMALECG1PWAVEATRIALDEPOLARIZATIONLAMPLITUDE020MVLDURATION011SECLPOSITIVEINI,II,AVF,V4V6NEGATIVEINAVR2PRINTERVALTHETIMEFORINTRAATRIAL,AVNODAL,ANDHISPURKINJECONDUCTION,DURATION012020SEC3QRSCOMPLEXVENTRICULARDEPOLARIZATIONLTHEWIDTH006010SEC,011SECLFROMV1TOV6,THERWAVESGETSBIGGERANDBIGGER,THESWAVESGETSSMALLERANDSMALLERLR/SLINV1,BUTR/SLINV5LRINV5ANDV625MV,RINV110MVLRINAVR05MV,LRINAVL12MVANDRINAVF20MVLRINI15MVLQ004SECINWIDTH,1/4RINTHESAMELEAD4STSEGMENTITREFLECTSPHASE2OFTHEACTIONPOTENTIALLSTELEVATION03MVINV1、V205INV3,010MVINV4V6LSTDEPRESSION005MVINANYLEADS5TWAVEREPOLARIZATIONOFVENTRICLESITISUPRIGHTINALLTHEUNIPOLARLEADSEXCEPTAVR,ANDOCCASIONALLYV1TWAVE1/10RINTHESAMELEAD,MAYBE1215MVINTHEPRECORDIALLEADS6QTINTERVALTHEDURATIONOFDEPOLARIZATIONANDREPOLARIZAIONOFVENTRICLESTHENORMALRANGEIS032044SEC7UWAVETHEWAVEFOLLOWINGTHETWAVEANDISUSUALLYVERYSMALLITSCAUSEISNOTCOMPLETELYUNDERSTOODELEVATEDUWAVELOWKINPLASMACSUMMARYWHYECGCOULDBESERVEDFORTHEDIAGNOSISOFSOMEDISEASESHOWDOESECGWORKWHATISECGWHATISNORMALECG1BASICKNOWLEDGEOFECGELECTROCARDIOGRAMDEPOLARIZATIONANDREPOLARIZATIONVECTORANDRESULTANTVECTORPACINGANDCONDUCTINGSYSTEMOFTHEHEARTLEADSYSTEMLIMBLEADSI,II,III,AVR,AVL,AVF,CHESTLEADSV1,V2,V3,V4,V52NORMALECGPWAVE,QRSCOMPLEX,TWAVE,UWAVE,PRINTERVAL,QTINTERVAL,STSEGMENT,RRPPMEANQRSAXISCLOCKWISEANDCOUNTERCLOCKWISEROTATIONNORMALVALUEANDSHAPELAMPLITUDEOFWAVESORSEGMENTP,QRS,T,UANDSTLWIDTHORDURATIONOFWAVESP,QRS,T,ULDURATIONOFINTERVALSPR,QTLSHAPEOFWAVESQRS,TCLINICALSIGNIFICANCESOFABNORMALECGTESTINCLASSROOMPLEASETRANSLATETHEFOLLOWINGWORDSINTOCHINESEPRACTICEMAKEANECGBYYOURSELFFIRSTREADANDMEASUREYOURECGWI