1、Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,心電圖,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,心 電 圖 的 產(chǎn) 生,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,心 電 通 路,Department of Anesthesiolog

2、y, The First Hospital of NanHua University ZhiGang-ZHOU,3,3,非不應(yīng)期,4,4,絕對不應(yīng)期,5,5,總不應(yīng)期,超常期,6,6,1,2,A P 與 E C G 1,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,0期-QRS波去極化,A P 與 E C G 2,0期,2期,1期,3期,4期,1期-J點,2期-ST斷,3期-T波,4期-等電位線,Department of Anesthesiology, The First

3、Hospital of NanHua University ZhiGang-ZHOU,常 規(guī) 心 電 圖 的 波 形 組 成 和 測 量 示 意 圖,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 測 量,Department of Anesthesiology, The First Hos

4、pital of NanHua University ZhiGang-ZHOU,時間測量,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,峰值測量,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,電軸測量 ?,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang

5、-ZHOU,正 常 心 電 圖 1,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,正 常 心 電 圖 2,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,正常心電圖特征及正常值 (1)心電圖紙：小方格=0.04s(橫)0.lmV(縱)； (2)心率：正常為60100bpm之間； (3)心律：竇性心律（、aVF、V4-6直立，aVR為倒置） (4)P波： 、aV

6、F、V4-6直立，aVR為倒置； T0.11S；電壓：肢導(dǎo)0.25mV，胸導(dǎo)0.2mV； (5)P-R間期：P波開始至QRS波群開始的時間。正常范圍為0.120.20s； (6)QRS波群：時間：0.060.10s； (7)ST段：自J點開始至T波開始的一段。sT段平行的壓低或斜向下的壓低不正常，輕度抬高可見于正常人； (8)T波；aVR導(dǎo)聯(lián)倒置，余在R波高于0.5mV時均應(yīng)直立； (9)U波：V2-3中易見，正常應(yīng)直立； (10)Q-T間期：QRS波開始至T波終了的間期，Q-T間期與心率不符合的延長有較重要意義。異?？s短多為藥物或電解質(zhì)紊亂影響。,Department of Anesthes

7、iology, The First Hospital of NanHua University ZhiGang-ZHOU,竇 性 心 律 失 常,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,竇性心動過速 Sinustachycardia,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,竇性心動過緩 Sinusbradychycardia,Department

8、 of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,特點: 1Pvl負(fù)向波0.04s，深1.0mm。 2. P時間常超過O.11s。 3 .P出現(xiàn)雙峰，峰距常超過0.04s。 4P波寬度與P-R段之比超過1.6,左房擴(kuò)大leftatrialenlargement,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,右房擴(kuò)大RightAtrialEnlargement,特點: l.P波時間不

9、延長 2.Pv1高達(dá)0.15mv或P高達(dá)0.25mv 3.本圖除右房大外，還有電軸右偏,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,左心室肥厚 leftatrialhypertrophy,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,左心室肥厚特點 1、QRs波群電壓的改變： A.肢導(dǎo)：R15mV，R+S25mV； Ravl0.7，Ravf2.0mv B.

10、胸導(dǎo): Rv5+Sv13.5mV(女)，4.0mV(男)； R5/R6+Sv1Sv34.Omv 2、心電軸：+030度屬電軸左偏，電軸左偏對診斷只有參考價值； 3、QRS時間延長：可延長0.09s，但不超過0.11s； 4、ST-T波改變： 以R波為主的導(dǎo)聯(lián)ST段下降超過0.05mv，T波倒置，屬不正常； 原因：繼發(fā)性或原發(fā)性； 5、目前認(rèn)為電壓增高加以STT改變，診斷左心室肥厚最為準(zhǔn)確； 僅有ST改變者為左心室“勞損”,勞損的改變有時呈可逆的； 僅有電壓升高不能屬于器質(zhì)性病變，應(yīng)屬于正常范圍心電圖。,Department of Anesthesiology, The First Hospit

11、al of NanHua University ZhiGang-ZHOU,右心室肥厚 RightVentricularHypertrophy,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,右心室肥厚特點: 1.QRS：Rv11.OmV；v1： RSl； V5：RS1.2mV RavR0.5mv，avR：RQ； 2.心電軸右偏可達(dá)+110，對診斷右心室肥厚有較大意義； 3.V1的室壁激動時間超過0.03s，診斷意義較大； 4.ST-T改變；V1、V2的ST下降，Tv1倒置，有參

12、考價值,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,雙 側(cè) 心 室 肥 厚,顯著電軸右偏 顯著順鐘轉(zhuǎn)位 V1導(dǎo)聯(lián)R/S1 RavR0.5mv V1的室壁激 動時間0.03s,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,雙 側(cè) 心 室 肥 厚,近似正常心電圖,出現(xiàn)一側(cè)肥厚心電圖改變,出現(xiàn)兩側(cè)肥厚心電圖特征,Department of Anesthesiol

13、ogy, The First Hospital of NanHua University ZhiGang-ZHOU,房 室 傳 導(dǎo) 阻 滯,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,一度房室傳導(dǎo)阻滯firstdegreeheartblock,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,2：1房室傳導(dǎo)阻滯 2to1AVblock,Department o

14、f Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,度1型：P-R間期逐漸延長，直至P波落在房室結(jié)區(qū)的絕對不應(yīng)期時，出現(xiàn)一次完全阻滯； 可見于健康人，也可因迷走神經(jīng)刺激如頸動脈竇受壓、洋地黃中毒等所引起，多為暫時性，無需特殊治療； 度2型：系希氏束浦頃野纖維傳導(dǎo)系統(tǒng)病變所致，PR間期正?；蜓娱L，部分P波后無QRS波，房室阻滯比例多為2:1或3:1。型預(yù)后嚴(yán)重，多數(shù)存在房室結(jié)、房室束纖維化病變或損害，且有演變?yōu)槎華VB的危險，藥物治療或需安置起搏器治療； 單純2度，無血流動力學(xué)紊亂情況，只要做好維護(hù)血流動力

15、學(xué)穩(wěn)定、無缺氧CO2蓄積、輸液輸血合理即可。術(shù)中伴有血流動力學(xué)顯著波動（如血壓下降，心率增快、缺氧、CO2蓄積等），則很可能轉(zhuǎn)為3度AVB，必須有置入起搏器的準(zhǔn)備,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,完全性房室傳導(dǎo)阻滯 CompleteHeartBlock, P波與QRS波均規(guī)律發(fā)生，但P波與qrs波完全無關(guān)， 心電圖診斷 1.竇性心律不齊 2.度房室傳導(dǎo)阻滯，室性逸搏心律,Department of Anesthesiology, The First Hospit

16、al of NanHua University ZhiGang-ZHOU,完全性房室傳導(dǎo)阻滯伴心房纖顫 trialfibrillationandcompleteheartblock,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,右束支傳導(dǎo)阻滯 RightBundleBranchBlock,V1呈rsR，其余導(dǎo)聯(lián)終末波粗 qrs時間0.12秒，為完全性右束支傳導(dǎo)阻滯,Department of Anesthesiology, The First Hospital of NanH

17、ua University ZhiGang-ZHOU,房性早搏 AtrialPrematureBeat,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,房性早搏二聯(lián)律 AtrialBigeminy,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,房 顫 的 形 成,Department of Anesthesiology, The First Hospital

18、of NanHua University ZhiGang-ZHOU,心房纖顫伴左束支阻滯Atrialfibrillationwithpre-existingLBBB,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,鋸齒狀規(guī)則的F波，頻率300次/分左右 患者因服用地高辛過量導(dǎo)致房室傳導(dǎo)阻滯，心室律緩慢,心 房 撲 動 AtrialFlutter,Department of Anesthesiology, The First Hospital of NanHua Universi

19、ty ZhiGang-ZHOU,鋸齒狀的F波一般在，AVF導(dǎo)聯(lián)明顯，有些時候在V1導(dǎo)聯(lián)明顯 當(dāng)心室率在150次/分的時候，應(yīng)該想到可能有房撲2：1下傳,心房撲動2：1傳導(dǎo) Atrialflutterwith 2:1AVconduction,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,交界性早博,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,特點: 提前的寬

20、大畸形的QRS波，T0.12S，其前無相關(guān)P波，代償間歇一般完全 一次正常搏動后就有一次室早，稱室早二聯(lián)律,室早 Ventricularprematurebeats,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,特點： 1.急性下壁心梗 2.室早二聯(lián)律,急性心梗伴室早,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,特點: QRS寬大，形態(tài)多變 R-R間距多變

21、 QRS波看上去像圍繞基線扭轉(zhuǎn) 可見于以下情況 心臟傳導(dǎo)阻滯 低血鉀或低血鎂 藥物（如：三環(huán)類抗抑郁劑過量） 先天性QT延長綜合征 其他QT延長的原因,尖端扭轉(zhuǎn)性室性心動過速,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,W-P-W綜合癥 Wolff-Parkinson-Whitesyndrome,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,PR間期縮短，

22、0.12s 沒有波 下側(cè)壁ST-T改變和左室高電壓,L-G-L綜合癥 Lown-Ganong-LevineSyndrome,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,急性下壁心梗Acuteinferiormyocardialinfarction,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,急性前壁心梗 Acuteanteriormyocardialin

23、farction,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,下壁前壁心肌梗塞并左束支阻滯,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,1.、AVF異常Q波: T0.04S,H同導(dǎo)聯(lián)R波的1/4 2. 房顫,陳舊下壁心梗,Department of Anesthesiology, The First Hospital of NanHua Universi

24、ty ZhiGang-ZHOU,1.QT間期縮短 2.特征性ST-T改變：ST-T融合呈魚鉤樣改變(V5,V6） 3.節(jié)律異常（一般見于洋地黃中毒） 室性或房性早搏 陣發(fā)性房速及不同程度的房室傳導(dǎo)阻滯 室速，室顫 其他,洋地黃效應(yīng)Digitaliseffect,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,低鉀血癥 Hypokalaemia,1.T波變小或消失 2.U波增高突出 3.到度房室傳導(dǎo)阻滯 4.ST段輕微壓低,Department of Anesthesiology, The First Hospital of NanHua University ZhiGang-ZHOU,1.P波變小或消失 2.房顫 3.QRS波增寬 4.ST段變短或消失 5.T波基底部變窄，T