> 8. 5 mmol /L P Brugada V1 - V3 ST Levine 2 QRS Brugada 1 Liu R Chen J. Dialyzable currents of injury in

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1 Dec J Liaoning Medical University 心电图是诊断高钾血症判定程度和观察疗效的重要指标本文结合我们临床心电图资料和文献复习, 简述高钾血症临床心电图分析困惑的问题 : 变可影响持久性房颤心脏起搏和旁路传导等复杂心电图改变高钾致窦室传导阻滞引起酷似急性心肌梗死和 Brugada 样改高钾血症 ; 心电图 ; 窦室传导阻滞 ; 心肌梗死 ; 心房纤颤 ; 心脏起搏 ; 预激综合征 R A A Clinical Concern in Electrocardiograms Hyperkalemia CHEN Juan LIU Renguang The First Affiliated Hospital of Liaoning Medical University Jinzhou China Abstract Electrocardiogram was an important index in the diagnosis of hyperkalemia its severity analysis and the therapeutic effect. This article briefly stated the confusing issues in the analysis of clinical electrocardiogram of hyperkalemia with the combination of literature review and our clinical data hyperkalemia led to sophisticated electrocardiographic changes such as sinoventricular conduction block mimicking acute myocardium infarction Brugada - type patterns conversion of persistent atrial fibrillation cardiac pacing and accessory pathway conduction. Key words hyperkalemia electrocardiogram sinoventricular conduction block myocardium infarction atrial fibrillation cardiac pacing pre - excitation syndrome > 5. 5 mmol /L 3 > 10 mmol /L QRS T T QT 2 0 dv /dt > A B C D E mmol /L QRS mmol /L A > 7. 0 mmol /L P V > 8. 5 mmol /L P

2 > 8. 5 mmol /L P Brugada V1 - V3 ST Levine 2 QRS Brugada 1 Liu R Chen J. Dialyzable currents of injury in potassium intoxication resembling acute myocardial infarc /s Levine HD Wanzer SH Merrill JP. 6 tion or pericarditis J V1 r QRS 0 2 ST 2. 3 f J f 6 Pastor JA Castellanos A Moleiro F et al. P 4 J Electrocardiol P J Barold SS Falkoff MD Ong LS et al Barold 8 1 DDD Electrolyte disorders and arrhythmo mmol /L Kahloon 9 1 DDD mmol /L mmol /L 12 El - Sherif N Turitto G. genesis J Sirdharan mmol /L 6 17 Sinoventricular conduction with Wenckebach block Danger signs of hyperkalemia J. Herz 2013 DOI. Circulation Antzelevitch C Brugada P Borggrefe M et al. Brugada Syndrome report of the second consensus conferece J. Circulation Liu R Chang Q. Hyperkalemia - induced Brugada pattern with electrical alternans J. Ann Noninvasive Electrocardiol.. Patterns of acute inferior wall myocardial infarction caused by hyperkalemia J Hyperkalemia induced failure of atrial capture during dual chamber cardiac pacing J. J Am Coll Cardiol Kahloon MU Aslam AK Aslam AF et al. Hyperkalemia induced failure of atrial and ventricular pacemaker capture J. Int J Cardiol Sridharan MR Flowers NC. Hyperkalemia and Wolff - Parkinson - White type preexcitation syndrome J. J Electrocardiol. 1 J Cardiol J Hughes H Tyers F Torman H. Effects of acid - base imbalance on myocardial pacing threshold J. J Thorac Cardiovasc Surg

3 辽宁医学院学报 2013 年 12 月图2 患者住院期间 4 次心电图A. 为入院时心电图示陈旧性前间壁心肌梗 B. 为血钾 mmol / L 时心电图示 P 波降低 QＲS 增宽 TV2 V4 增高 C. 为血钾 mmol / L 时心电图示 P 波消失 QＲS 进一步增宽为窦室传导 D. 为血钾进步增高心室停搏前心电图示窦房传导的文氏现象 QＲS 增宽达 s 图3 QＲS 波群呈均匀增宽时间 s V1 导联呈 qｒ型 V2 导联呈 qｒs 型 V1. 2 导联 J 点明显抬高其后 ST 段呈下斜型 V2 呈马鞍型抬高在长描 V2 中可见 QＲS J 波 T 电交替第组心搏 S 波明显减小 J 波增大 T 降低心电图示高钾血症导致窦室传导室内阻滞伴 Brugada 样心电图改变和电交替

4 陈娟等高钾血症临床关注的心电图问题图4 65 P 波消失 A. 入院心电图示心房纤颤 B. 示窦性心律 52 次 / 分 Ⅰ度房室传导阻滞急测血钾 5. 7 mmol / L C. 按高钾给予处理血钾降为 4. 2 mmol / L 时又转为房颤图5 患者治疗中的 4 份心电图A. 为患者入院时的心电图示心房纤颤 B. 为应用洋地黄后心率变缓慢规则血钾 mmol / L 时心电图 C. 为血钾 5. 5 mmol / L 时心电图 1 mv 20 mm D. 血钾降至 4. 5 mmol / L 时心电图转回心房纤颤 1 mv 20 mm

5 辽宁医学院学报 2013 年 12 月图6 A. 入院心电图示 QＲS 波群前均有 P 波 PＲ s QＲS 波群宽大畸形其前有预激波测血钾 mmol / L B. 为血钾 mmol / L 时记录心电图 PＲ s QＲS 时限 s 预激波消失 14 Yakaitis ＲW Cooke JE Ｒedding JS Ｒe evaluation of rela- 16 Almukdad H Hyperkalemia revisited J Saudi Kidney Dis 17 Mehta NJ Chhabra VK Khan LA Sinus arrest or sinoven- Transplant tionships of hyperkalemia and PCO2 to cardiac arrhythmias during mechanical ventilation J Current Ｒesearches tricular conduction in mild hyperkalemia J J Emerg Med Fisch C Electrolytes and the heart In Hurst JW ed The Heart 6th ed M New York McGraw Hili 1986 收稿日期腮腺肿瘤切除术面神经保护的研究进展梁艳张永超综述谷京城审校辽宁医学院附属第一医院耳鼻咽喉头颈科辽宁锦州摘要整理 2006 年以来关于腮腺肿瘤切除围手术期面神经保护的文献资料就解剖手术方法术中监护面神经修补吻合术后处理等方面作以介绍关键词腮腺肿瘤; 面神经保护; 肌电监测; 神经修补中图分类号Ｒ文献标志码 A 文章编号作者简介梁艳 1989 女山东济宁人在读硕士研究生主要研究方向为耳鼻喉头颈外科通讯作者谷京城 1955 男辽宁锦州人教授硕士学位主要研究方向为耳鼻喉头颈外科

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