心率失常心电图总结(新大纲新增)

心率失常心电图总结(新大纲新增) 心 电 图 第一节 临床心电学的基本知识 1.心电图产生原理 • 静息状态 外正内负 • 除极(depolarization)状态 外负内正 电源前 电穴后 电极对向电源--向上 波形 • 复极(repolarization) 电源后 电穴前 电极对向电源--向下波形 • 复极方向与除极方向相反 心外膜向心内膜 • 心电向量(vector) 具有强度和方向性的电位幅度 – 与心肌细胞数量呈正比 – 与探查电极位置和心肌细胞距离呈反比 – 与探查电极的方位和心肌除极的方向夹角呈反比 • 心电综合向量原则 2.心电图各波段的组成和命名 • P波:心房的除极过程 • P-R段(P-Q段):心房复极过程及房室结、希氏束、束支的电活动 • P-R间期:自心房开始除极至心室开始除极 • QRS波群及命名:心室除极 ST段和T波:心室缓慢和快速复极 • • Q-T间期:心室开始除极至心室复极完毕 3.心电图导联体系 • 肢体导联(limb lead) – Einthoven三角 – 标准 excel标准偏差excel标准偏差函数exl标准差函数国标检验抽样标准表免费下载红头文件格式标准下载 导联--双极肢体导联 I II III – 加压单极肢体导联 aVL aVR aVF – 额面六轴系统 • 胸导联(Chest lead) – 单极导联V1-V6 – 肢体导联三个电极各串一5kW电阻，将三者连接起来，构成无干电极，为负 极 第二节 心电图的测量和正常数据 1.心电图测量 • 走纸速度25mm/s时，纵线1mm=0.04s 标准电压1mV=10mm时，横线1mm=0.1mV • 心率的测量:60/R-R或P-P间期的秒数 • 各波段振幅的测量:QRS波起始前的水平线上缘到波顶，下缘到波底 • 各波段时间的测量 – 12导同步心电图 • P波、QRS波、Q-T间期从最早起点至最晚终点 • P-R间期从最早P起点至最早QRS起点 – 单导心电图 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet • P波、QRS波:最宽的P波、QRS波 • P-R间期:最宽大P波且有Q波 • Q-T间期最长 – 测量各波时间应自波形起点的内缘测至波形终点的内缘 • 平均心电轴: – 概念:平均QRS电轴，是心室除极过程中全部瞬间向量的综合， 说明 关于失联党员情况说明岗位说明总经理岗位说明书会计岗位说明书行政主管岗位说明书 心室在 除极过程的总时间内的平均电势方向和强度，是额面电轴 – 测定 方法 快递客服问题件处理详细方法山木方法pdf计算方法pdf华与华方法下载八字理论方法下载 :I、III;目测;代数和 – 临床意义 • - 30? ~ +90? 正常范围 • +90? ~+180? 右偏 右心室肥大 左后分支阻滞 • - 30? ~ - 90? 左偏 左心室肥大 左前分支阻滞 • - 90? ~- 180? 极度右偏 • 心脏循长轴转位 – 心尖?心底 – 顺钟向转位 右心室肥大 – 逆钟向转位 左心室肥大 2.正常心电图波形特点和正常值 • P波 心房除极的电位变化 – 形态:圆形 偶有切迹 • 综合向量:左、前、下 • I、II、AVF、V4-V6向上;AVR向下 – 时间:< 0.12S – 振幅:肢导 < 0.25mV;胸导 < 0.2mV • P-R间期 心房开始除极至心室开始除极的时间 – 正常范围:0.12~0.20s – 心动过速时缩短，心动过缓时延长 ? 0.22s • QRS波群 心室肌除极的电位变化 – 时间:0.06 ~0.11s – 波形和振幅 • V3 R/S=1 • V1< 1mV • V5、V6 < 2.5mV • AVR < 0.5mV • AVL < 1.2mV • AVF < 2.0mV • I、II、III主波向上 • 肢体导联<0.5mV或胸前导联<0.8mV为低电压 • Q波:振幅<同导联1/4R，时间<0.04S • J点:自QRS波群的终末与ST段起始之交点 • ST段:自QRS波群终点与T波起点间的线段代 表 关于同志近三年现实表现材料材料类招标技术评分表图表与交易pdf视力表打印pdf用图表说话 pdf 心室缓慢复极过程 – 下移<0.05mV;抬高 V1、V2 <0.3mV;V3 <0.5mV • T波:代表心室快速复极时的电位变化 – 方向:与主波一致 ;振幅:> 同导联R波的1/10 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet • Q-T间期:从QRS波的起点至T波终点，代表心室肌除极和复极全过程所需的时间 – 正常范围:0.32-0.44s – 校正Q-Tc= Q-T/ R-R • U波:T波后0.02~0.04s的振幅很小的波，代表心室后继电位 第三节 心房、心室肥大 1.心房肥大 • 右房肥大(right atrial enlargement) – P波高尖，振幅?0.25mV，II、III、AVF显著又称“肺性P波” • 左房肥大(left atrial enlargement) – P波增宽?0.12s，I、II、R、L; – 呈双峰，两峰间距?0.04s，又称“二尖瓣型P波” – P波终末电势(Ptf):V1负向P波时间乘以负向波振幅?0.04mm.s • 双心房肥大波增宽?0.12s,振幅?0.25mV 2.心室肥大 • 左室肥大(left ventricular hypertrophy) – Rv5/v6 >2.5mV – Rv5+Sv1>4.0mV(男) >3.5mV(女) – RI >1.5mV, RaVL >1.2mV, RaVF >2.0mV RI+SIII>2.5mV – – 额面电轴左偏 – QRS时间0.10~0.11s – 左室肥大劳损RS波群增高伴ST-T改变 • 右室肥大(right ventricular) – V1 R/S ?1,V5 R/S?1, 重度肥厚V1呈qR型 – Rv1+Sv5>1.05mV – 电轴右偏 – ST-T改变 • 双侧心室肥大(biventricular hypertrophy) – 正常或一侧肥大表现 第四节 心肌缺血与ST-T改变 1.心肌缺血的心电图类型 • 缺血型心电图改变 – 由心外膜?心内膜 – 心内膜下心肌缺血 T波高尖 – 心外膜下心肌缺血 T波倒置 • 损伤型心电图改变 – ST-T:从正常心肌?损伤心肌 – 心内膜下ST段压低 – 心外膜下ST段抬高 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet – 机制 综治信访维稳工作机制反恐怖工作机制企业员工晋升机制公司员工晋升机制员工晋升机制图 : 轻度缺血:钾离子进入细胞?过度极化?损伤电流?缺血导联ST压低 严重缺血:钾离子溢出细胞?极化不足?损伤电流?缺血导联ST抬高图6-5 • 临床意义 – ST压低/T波倒置:典型心绞痛/慢性冠不全 – ST抬高/T波高尖:变异型心绞痛/心肌梗死 – 其它:心肌病 心包炎 药物 继发改变 第五节 心肌梗死 (myocardial infarction) 1.基本图形及机制 • 缺血型改变 (T波) – 心肌复极时间延长 3位相延长 – – QT延长 • 升支与降支对称 • 顶端呈尖耸的箭头状 • 由直立变倒置 损伤电流学说 Prinzmetal 测得损伤区细胞膜4时相极化程度低 • • 正常心肌电流流向损伤心肌--舒张期损伤电流 • 向量方向与损伤电流方向相反 • 背离探查电极 • 心内膜下ST段压低 • 心外膜下ST段抬高 除极波受阻学说 • 正常心肌除极后呈负电位 • 损伤心肌不除极呈正电位 • 产生电位差 • ST向量由正常心肌指向损伤心肌 • 面向损伤区的导联出现ST段抬高 • 损伤型改变(ST段) – 超急性ST段抬高 – 损伤期单向曲线 – 机制 损伤电流学说 除极受阻学说 • 坏死型改变 – 异常Q波 宽度0.04，深度1/4R – Q波镜面相 – 正常q波消失 – QRS波正常顺序的改变 – 机制 坏死组织不产生心电向量，正常组织照常除极，产生与梗塞部位相反的 综合向量 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet 2.心肌梗死的图形演变及分期 • 早期(超急性期) 数小时 – 急性损伤性传导阻滞:QRS高/宽 – ST斜型抬高(下壁)，T波高耸 • 急性期 数小时--数周 – QS/QR波 – ST段单向曲线，T波倒置加深 • 亚急性期 数周--数月 – ST段恢复至基线，T波变浅 • 陈旧期(愈合期) 3-6月后 – QS ST-T恒定，可出现r/R 3.心肌梗死的定位诊断 • 前间壁: V1、V2 • 前 壁: V3、V4 • 前侧壁: V5、V6、aVL • 广泛前壁:V1--V6 • 高侧壁: I、aVL • 下 壁: II、III、aVL • 正后壁: V7、V8、V9 右 室: V3R、V4R、V5R • 4.心肌梗死的不典型图形改变 • 非Q波心肌梗死 – 心内膜下心肌梗死 – 局灶心肌梗死 5.鉴别诊断 • ST段抬高:早期复极综合征、急性心包炎、变异型心绞痛、Brugada综合征 • V1、V2:心脏转位、左室肥厚、LBBB、高度肺气肿，qRs/qrS波多为陈旧前间 壁心肌梗死 • I、aVL、V5、V6:心肌病、正常心电图 • II、III、aVF:心脏横位、预激综合征 第六节 心律失常(arrhythmia) 1.概述 窦性心律失常 起源异常 被动性:逸搏与逸搏心律(房性、室性、房室交界) 异位心律 期前收缩 (房性、室性、房室交界) 主动性 心动过速(房性、室性、房室交界) 扑动与颤动(心房、心室) 生理性传导障碍:干扰与脱节(包括心脏的各个部分) 心律失常 窦房阻滞 房内阻滞 传导异常 病理性传导阻滞 房室传导阻滞 室内阻滞 意外传导 传导途径异常:预激综合征 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet 2.心律失常心肌电生理 • 自律性:心肌在不受外界刺激的影响下能自动地、规律地产生兴奋及发放冲动的特性。 – 静息状态下，4位相自动缓慢除 – 心房肌、心室肌无起搏功能 – 窦房结、冠状窦区、心房传导组织、房室交界区、希氏束、束支、蒲肯野纤维 – 窦房结60--100次/分 – 房室交界区40--60次/分 – 希氏束以下25--40次/分 • 兴奋性:心肌细胞对受到的刺激作出应答性反应的能力 – 绝对不应期(absolute refractory period): 200ms; 任何刺激不能引起反应。 其后10ms强刺激科引起局部兴奋产生新的不应期，但不能扩布称有效不应期(effective refractory period) – 相对不应期:50~100ms动作电位-60~-80mV，除极速度振幅低，传导慢，不应期短 – 总不应期:250~400ms;有效不应期+相对不应期 – 易损期:心电图T波顶峰前约30ms处;R on T 90mV，低于阈值的刺激也激发动作电位的产生 – 超常期:动作电位-80~- • 传导性:心肌激动能自动向周围扩布;蒲肯野纤维及束支传导速度400mm/s;房室结20~200mm/s – 影响因素:动作电位幅度和0相除极速度 收缩性 • 第六节心律失常 (Cardiac arrhythmias) 1.心律失常概述 – 冲动形成异常 • )有正常自律性:窦结、结间束、冠状窦口附近、房室结远端、希)氏束-蒲肯野系统?植)物神经系统兴奋性改变或内在病变。 • )无自律性心肌细胞:心房和心室肌细胞由于缺血、药物等?异常自律性。 – 心脏传导系统的解剖 – .窦房结(Sinus node):位于右心房与上腔静脉交接处，.主要由P细胞(起搏细胞)、过渡细胞、心房肌细胞组成。 – .结间束: – (1)前结间束:发自窦房结前方分为两束，一束到左心房，一束进入房间隔。 – (2)中结间束:起自窦房结后部到房间隔后上部。 – (3)后结间束:起自窦房结后部到房室结 – (James?fiber-预激综合征) – .房室结 2(心律失常的发生机制 (1)冲动形成异常 • )有正常自律性:窦结、结间束、冠状窦口附近、房室结远端、希)氏束-蒲for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet 肯野系统?植)物神经系统兴奋性改变或内在病变。 • )无自律性心肌细胞:心房和心室肌细胞由于缺血、 药物等?异常自律性。 (2).触发活动:指局部出现儿茶酚胺浓度增高、低血钾、高血钙与洋地黄中毒时，心房、心室与希氏束-蒲肯野组织在动作电位后产生除极活动，被称为后除极。若后除极的振幅增高并抵达阈电位便可引发触发活动。 (3)冲动传导异常 传导速度延缓—与细胞的膜反应性有关。 动作电位[0]相的振幅。 dv/dt值(除极速度) 递减传导—膜电位有关 膜的静止电位在-90mv传导最快 膜的静止电位在-55mv传导阻滞 膜的静止电位在-65mv —-70mv可传但速度慢动作电位[0]相的振幅及dv/dt逐渐减少?发生传导阻滞?递减传导。 单向阻滞:心肌细胞正常都是双向的。 超常期传导:在心动周期的某个时候，若心脏某部分的传导得到暂时的意外改善称为超常期传导。最常见的部位在房室连接区，其次是室内传导，其表现是一个激动到达这些部位时本应受阻，但意外下传或传导时间本来延长，而这时缩短。 4.折返现象(图2-11P19) 当一激动从心脏某处发生后，经过向下传导又回到原处再次引起激动，这种现象叫折返现象。三个条件(1)有一个环行通道使激动可以循环运行。(2)环行通道的一部分出现单向传导阻滞。(3)传导速度减慢。 二、心律失常的诊断 – .病史: )心律失常的存在及类型 ? ? )心律失常的诱发因素 ? )心律失常发作的频率与起止方式 ? )心律失常对病人造成的影响及后果 – .体检心率、心律 – .心电图: ? )心房与心室节律是否规则，)频率如何, ? )PR间期是否恒定, ? )P波与QRS波群形态是否正常, ? )P波与QRS波群相互关系 – .动态心电图 – .运动试验 – .食道心电图 – .信号平均技术:微伏级的心电信号，.监测心室晚电位预测心梗猝死。 – .临床心电生理检查:适应症 ? )病态窦房结综合征 ? )房室与室内传导阻滞 ? )心动过速 ? )不)明原因晕厥 第二节 窦房节性心律失常 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet ? 、窦性心动过速(Sinus tachycardia) ? .心电图特点 ? )频率100-200次/分 ? )P波在I、II、avF导联直立，)avR倒置 ? )PR间期0.12-0.20秒 ? (图一窦性心动过速) ? .临床意义 ? )健康人、活动、情绪 ? )病理状态 ? )药物肾上腺素、阿托品 ? .治疗:针对原发病，.去除病因 ? 、窦性心动过缓(Sinus bradycardia) ? .心电图 ? )频率<60次/分 ? )可同)时发生心律不)齐 ? (图二窦性心动过缓) ? .临床意义 ? )健康人、运动员、睡眠 ? )病理状态:颅内疾患、严重缺氧、低温、甲减、病窦、急性心肌梗塞 ? )药物:拟副交感药物、β-阻滞剂、钙拮抗剂 ? .治疗:无症状无需治疗 有症状:心排血量不足，伴有快速心律失常应用药物或心脏起搏。 ? 、窦性停搏或窦性静止(Sinus pause or sinus arrest) ? .心电图 ? )PP间期显著延长 ? )长的PP间期与基本的窦性PP间期无倍)数关系。 ? )长时间的窦停后出现单个逸搏或逸搏性心律。(图窦停) ? .临床意义 ? )迷走神经张力增高或颈动脉窦过敏。 ? )病理状态:AMI、窦房结病变、纤维化、脑血管意外。 ? )药物:洋地黄、奎尼丁、钾盐、乙酰胆碱。 治疗:同心动过缓 ? 、窦房阻滞(Sinoatrial block) ? .心电图分三度 ? )一度—窦房结电位不)显示故无法诊断。 ? )二度—I型PP间期进行性缩短直至出现一个长PP间期，)该长PP间期短于 基本PP间期的两倍)。 ? )二度—II型长PP间期为基本PP间期的两倍)，)可出现逸搏。 ? )三度与窦停鉴别。 ? (见图) ? .临床意义同.窦停 ? .治疗同.病窦 ? 、病态窦房结综合征(sick sinus syndrome) ? 由于窦房节病变导致功能减退，产生多种心律失常的综合表现。 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet ? .病因 ? )各种病变淀粉样变性、甲减、感染、纤维化、硬化与退行性变。 ? )迷走神经张力过高。 ? )抗心律失常药抑制窦房结功能。 ? .临床表现:心脑脏器供血不.足 ? .心电图 ? )非药物所致持续而)显著的心动过缓。 ? )窦停与窦房阻滞 ? )窦房阻滞与房室传导阻滞并存。 ? )心动过速—心动过缓综合征 ? .心电生理检查 ? )固有心率低于正常人118.1-(0.57*年龄)。 ? )窦房结恢复)时间不)超过2毫秒，)窦房传导时间不)超过147毫秒。 ? .治疗:无症状-不.治疗，.有症状-起博器 第三节 心房性心律失常 ? 、房性早搏(atrial premature beats) ? .心电图 ? )P波提前出现，)与窦性P形态各异。 ? )房早未下传或缓慢传导(下传的PR延长)。 ? )QRS波群正常。 ? )代偿间歇完全或不)完全。 ? (图房早) ? .治疗: ? )通常无需治疗。 ? )去除诱因。 ? )药物治疗:镇静、β-阻滞剂、抗心律失常药物。 ? 、房性心动过速(atrial tachycardia) ? 分为自律性房性心动过速 ? 折返性房性心动过速 ? 混乱性房性心动过速 ? )自律性房性心动过速发生于 ? .临床特点 ? )发生于严重器质性心脏病病人。 ? )洋地黄中毒。 ? )发作短暂或持续数月。 ? .心电图 ? )房律150-200次/分，)P波形态与窦性不)同)。 ? )洋地黄中毒继续使用房律增快，)PR延长，)出现二度房室传导阻滞。 ? )P波等电位线存在。 ? )刺激迷走神经不)能终止心动过速，)仅加重房室阻滞。 ? )发作开始心率逐渐加速。 ? .电生理 ? )心房程序刺激不)能诱发心动过速。 ? )心动过速的第一个P波与随后的P波相同)。 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet ? )心房超速起搏能抑制心动过速，)但不)能终止其发作。 ? .治疗 ? )房速合并阻滞时，)心室率不)快可不)予处理。 ? )洋地黄中毒时 ? 停洋地黄 ? 血钾不高补钾(口服半小时5g) ? 高血钾给予普鲁洛尔、苯妥英、普鲁卡因胺与奎尼丁 ? )非洋地黄引起 ? 给予洋地黄 ? 奎尼丁、普鲁卡因胺普罗帕酮或胺碘酮 ? )折返性房性心动过速 ? 特点:1.器质性心脏病的患者。 ? 2. P波形态与窦性不同，PR延长。 ? 3. 心房程序刺激能诱发和终止。 ? 4.刺激迷走神经不能终止发作，但可产生房 ? 室阻滞。 治疗同室上性心动过速。 ? )混乱性房性心动过速 ? 特点: 1.发生于慢阻肺和心衰老人、洋地黄中毒、低血钾。 2.心电图3种以上形态各异的P波，PR间期各不相同。 ? .心房率100-300次/分。 ? .大多数P波能下传，.部分受阻，.心室率不.规则。 ? .治疗原发病，.维拉帕米、胺碘酮可能有效。 ? 、心房扑动(atrial flutter) – .病因: ? )阵发房扑可发生于无器质病变的心脏病者。 ? )持续房扑见于风心病、冠心病、高心病、心肌病、慢性充血性心衰、甲亢、 酒精中毒、心肌炎。 – .临床表现 ? )不)稳定—房颤或窦律，)偶有持续数月或数年。 ? )按摩颈动脉能减慢房波心室率。 ? )心室率不)快者无症状。 – .心电图 ? )规律的锯齿状扑动波，)等电位线消失，)II、III、avF、V1明显，)房率250-300 次/分。 ? )心室率规则或不)规则，)取决于房室传导比率是否恒定。 ? )QRS波群形态正常，)有差传或束枝阻滞时可增宽。 – .治疗 ? )药物治疗。 – .洋地黄: ? 通过迷走神经的作用?心房不应期缩短?房率增快?房扑变房颤?窦性心律。 ? 加重房室传导阻滞?心室率变慢。 ? 成功率40-60%。 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet – .奎尼丁、普鲁卡因酰胺延长心房不.应期，.转复.窦率，.成功率30-60%。 – .其它:β受体阻断剂减慢房室结传导，.胺碘酮延长心房有效不.应期转复.房颤。 ? )直流电复)律<50J。 ? )食道调搏超速抑制转复)。 ? )消融手术。 ? 、心房颤动(atrial fibrillation) ? )病因 – .阵发房颤可见于正常人、情绪激动、手术后、运动、酒精中毒。 .持续房颤可见于风心病、–冠心病、高心病、甲亢、缩窄性心包炎、感染性心内膜炎、心衰及慢性肺原性心脏病。 – .孤立性房颤见于无已知心脏疾患者。 临床表现 .症状轻重与心室率快慢有关，.–房颤时心排血量减少25%以上。 – .有较高体循环栓塞的危险，.中风的发病率明显增高。 – .体征:心音强弱不.等，.心律绝对不.齐，.脉搏短绌，.原发病的心脏体征。 – .房颤病人的心室率变规则应考虑: ? )恢复)窦性心律。 ? )房性心动过速。 ? )房扑伴固定的房室传导比率。 ? )发生房室交接性心动过速或室速。 ? )完全性房室传导阻滞。 (3)(4)(5)最常见于洋地黄中毒。 心电图 – .P波消失，.代之以大小不.等的f波，.频率350-600次/分。 – .心室率极不.规则在100-160次/分。 – .QRS波通常正常，.但可有室内差异性传导。 治疗 – .转复.:转复.前常规抗凝药物治疗3周。包括药物转复.、直流电复.律、射频消融术。 ? )药物 ? Ia类奎尼丁使用前应用β受体阻断剂减慢房室结传导。 Ib类普罗帕酮、氟卡尼 III类胺碘酮 – .减慢心室率 – 洋地黄、普萘洛尔、维拉帕米 ? 节房室交界区性心律失常 ? 房室交界性过早搏动 – .冲动起源于房室交界区。 – .提前产生QRS波群与逆行P波。 3.P波可位于QRS波群前、中、后。 – .QRS波群形态可正常。 ? 、房室交界性逸搏和心律 – .窦房结发放冲动减慢，.低于交界区。 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet – .传导障碍—窦房结冲动不.能下传。 .心电图—–较为正常的PP间期长的间歇后出现一个正常QRS波群，.P波在其前或后。 – .房室交界性心律指.房室交界性逸搏连续发生形成的节律，.频率35-60次/分，.室律超过房律，.房室分离。 – .生理性保护机制。 – .治疗—提高窦房结冲动发放频率，.改善传导。 ? 、非阵发性房室交界性心动过速 – .发生机制与交界区组织自律性增高或触发活动有关。 .病因—洋地黄中毒、下壁心肌梗塞、心肌炎、手术，.–偶见正常人。 – .心电图—心率逐渐变化70-150次/分，.QRS波群正常。 – .治疗基本病因，.无需特殊处理。 ? 、阵发性室上性心动过速 ? )房室结折返性心动过速 – .病因:无器质性心脏病患者。 – .临床表现 ? )突发突止，)心悸，)焦虑，)眩晕，)晕厥，)严重者心衰与休克。 ? )体检第一心音强度恒定，)心律匀齐。 3.心电图 (1)心率150—200次/分，节律规则。 (2)QRS波群正常，但可有差传，或原有束枝阻滞图形。 ? )逆行P波，)II、III、avF倒置，)常在QRS波群内或终末部。 起始突然，房早触发，PR间期显著延长，引起心动过速。 4.心电生理检查 ? )快径路传导速度快，)不)应期长。 ? )慢径路传导速度慢，)不)应期短。 ? )房早时，)快径受阻，)经慢径前传，)快径逆传。 – .治疗原则 刺激迷走神经无效?腺苷6-12mg或维拉帕米5-10mg、地尔硫卓0.25-0.35mg/kg，普萘洛尔0.25-0.5mg无效?直流电复律或食道调搏?射频消融术 ? )房室折返性心动过速 – .房室旁道，.经房室结前传，.旁路通道逆传，.QRS波群正常，.逆行P波落在ST或T波起始部。 – .心房或心室程控可诱发和终止心动过速。(图) ? 、预激综合征(preexcitation syndrome) ? 心房激动提前激动心室的一部分或全体。解剖基础房室间Kent束。 ? )临床特点 – .发病率1.5‰，.男性多，.可见于正常人、先心病、二尖瓣脱垂、心肌病。 – .心动过速(房室折返性心动过速、房颤、房扑)发生率1.8%，.预激本身无症状，.合并心动过速时可导致充血性心衰、低血压甚至死亡。 ? )心电图 – .PR<0.12秒。 – .QRS波群>0.12s，.其前有Δ波。 – .ST-T继发改变。 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet – .A型QRS波群均向上，.预激发生在左室或右室后底部。B型QRS波群V1向下，.预激发生在右室前侧壁。 – .正向房室结折返性心动过速最常见。 – .5%逆向房室结折返性心动过速，.QRS增宽，.与室速类似。(图预激心动过速伴房颤) ? )治疗:从无心动过速或偶有发作症状轻微无需治疗伴心动过速者治疗。 1药物 ? )正向房室结折返性心动过速处理同)房室结折返性心动过速，)刺激迷走神经?无效?腺苷、维拉帕米、普奈洛尔。机理:房室结传导减慢、不)应期延长，)对旁路传导无影响。 ? )洋地黄缩短旁道不)应期，)不)能单独用于曾有房颤或房扑患者。 ? )预激合并房颤或房扑发生晕厥低血压应立即电复)律，)或选择延长旁道与房室结不)应期的药物如普鲁卡因胺与普洛乃尔或普洛帕酮与胺碘酮。静注利多卡因与维拉帕米，)加重预激合并房颤心室率，)应禁用。 2射频消融术适应症: ? )心动过速发作频繁、药物不)能控制。 ? )房颤房扑经旁道快速传导，)心室率极快。 ? )药物治疗无法减慢心动过速心室率。 ? )心电生理检查房颤时旁道前向传导不)应期短于250ms。 第五节心室性心律失常 ? 、室性早搏(premature ventricular beats) ? )病因 正常人各种心脏疾患、缺血、缺氧、麻醉、手术、左室假腱索、药物中毒、电解质紊乱、烟酒、咖啡。 ? )临床表现:1心悸、重者晕厥，引发心绞痛、低血压。2听诊室早后长间歇，室早第二心音减弱。 ? )心电图:提前发生的QRS波群超过0.12秒，)宽大畸形，)T波与主波方向相反，)配对间期恒定，)代偿间期完全。间位性室早、二联律、三联律、单形性室早、多源性室早。室性并行心律:心室异位起搏点独立的规律发放冲动，)并能防止窦房节冲动侵入。心电图表现为配对间期不)恒定，)长RR间期是短RR间期的整倍)数，)可有室性融合波。 ? )治疗 1.无器质性心脏病，无名显症状，不频繁，单一室早不需药物治疗—镇静，调整生活方式，去除诱因。 – .有器质性心脏病，.室早>5次/分，.多源室早，.成对或连续室早，.“R on T”，.药物治疗。首选利多卡因，.其次普鲁卡因胺其次、安搏律定、胺碘酮。 二、室性心动过速(ventricular tachycardia) ? )病因: 1冠心病(AMI)。 2扩张型与肥厚型心肌病 3二尖瓣脱垂、心瓣膜病 4药物中毒 5长QT综合征 6无器质心脏病患者 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet ? )临床表现 1心悸、气短、血压降低、昏厥、阿-斯综合征 2查体:心率120-200次/分，轻度不规则，第一心音强弱不等，颈静脉规律巨大a波 心电图 1三个以上室早连续出现 2QRS波群宽大畸形>0.12s，ST-T与主波方向相反 3心率100-250次/分，规则 4房室分离 5心室夺获与心室融合波 ? )鉴别诊断:室性心动过速与室上性心动过速伴差传(图) ? )电生理检查:鉴别室性/室上性，)激动折返/自律性增强 1室上性心动过速V前都有H波，HV>30ms。 2心房调搏法:心房超速抑制，夺获心室的QRS波窄<0.10秒证明为室性心动过速 3程序刺激能诱发和终止心动过速为折返机制。 ? )治疗 原则:无器质性心脏病发生非持续性室速无症状无需治疗。有器质性心脏病发生非持续性室速及持续性室速均应治疗。 – .终止发作 )有血流动力学障碍者同)步直流电复)律100-200J开始，)重复)可达360J。? 洋地黄中毒不)宜复)律。 ? )无血流动力学障碍者首选利多卡因、普罗帕酮、胺碘酮。 ? )射频消融术 – .预防复.发 ? )治疗原发病，)去除诱因。 ? )选择疗效好、毒副作用小药物，)β阻滞剂、慢心律、普罗帕酮、胺碘酮。 ? )特殊类型的室速 1加速性室性自主心律(缓慢性室速) ? )心室率60-110次/分 ? )与窦性起搏点交替控制心律出现融合波 ? )见于AMI再灌注、心脏手术、心肌病、风湿热、洋地黄中毒 ? )无需治疗，)阿托品提高窦性频率消除加速性室性自主节律 2尖端扭转室速 ? )长QT综合征，)药物，)电解质紊乱，)颅内病变，)心动过缓 ? )QRS波群围绕等电位线扭转 ? )频率150-250次/分，)QT间期>0.5S，)U波明显 ? )进展为室颤、猝死 ? )肾上腺素依赖性长QT综合征，)β阻滞剂治疗 ? )治疗IB类和镁盐，)停用IAIC、III类药，)必要时起搏或颈胸交感神经切) 断术 ? 、心室扑动与心室颤动(ventricular flutter and ventricular fibrillation) 1临床表现:意识丧失、抽搐、呼吸暂停，心音消失，Bp0 2心电图: for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet ? )室扑呈正弦波图形，)频率150-350次/分 ? )室颤大小不)等颤波，)频率250-500次/分 ? )治疗:心肺复)苏，)人工呼吸，)除颤复)律 第六节心脏传导阻滞 ? 、房室传导阻滞(atrioventricular block) ? 房室交界区脱离了生理不应期后，心房冲动传导延迟或不能传导到心室。可发 生于房室结、希斯束，束支。分三度。 1病因:正常人、运动员-文氏。其他 2临床表现:无症状-疲倦、乏力、心悸-晕厥阿-斯综合征 听诊第一心音减弱，变化，大炮音 3心电图 I度AVB PR间期超过0.20秒，QRS正常，延缓大部分在房室结。 II度AVB –I型(文氏阻滞)，PR，RR间期 II度AVB –II型 III度AVB房室分离，房率快于室率，频率 4治疗 二室内传导阻滞 希斯束以下阻滞 心电图1右束支传导阻滞 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet