期前收缩后第1个窦性搏动T波转直立

患者男性,62岁。因胸闷心前区疼痛,气短来我院就诊,以往诊为冠心病。图为V_5导联连续描记,窦性心律,P-P间距0.88s,P-R间期0.16s,QT间期0.40s,ST段下移0.05mV,T波倒置,其中每行中提前出现的是交接性期前收缩(PNS),但值得注意的是PNS后第1个心动T波直立,QT间期0.52s,其余T波均为倒置。     

Brugada综合征一例报告

1 病例报告 患者男，46岁。因突发晕厥2次，于2005年10月17日入院。患者于入院前1d突发晕厥，持续几十秒后自行缓解，醒后觉心悸、头晕，不伴抽搐。追诉1年前也有类似情况发生，自述无晕厥家族史。入院查体血压130／80mm Hg（1mmHg=0．133kPa），一般情况良好，心界无扩大，心率110次／min，心律匀齐，各瓣膜区无病理性杂音，双肺呼吸音清，未闻及啰音，其余检查均正常，常规心电图示：窦性心律、心率1320次／min，P-R间期0．16s。QRS时限0．102s，Q-T间期0．344s，V1导联呈“右束支阻滞”图形，但V5、V6导联S波不增宽，粗钝，ST段在V1导联呈尖峰状抬高0．3-0．4mV，V3导联呈马鞍形抬高0.3mV。见图1。临床诊断：Ⅰ型Brugada综合征。     

室性期前收缩揭示3相阻滞及冠状动脉供血不足1例

患者女,51岁。临床诊断冠心病。图A示窦性心律,心率64次/min,P-R间期0.12s,呈完全性右束支阻滞图形,提早的QRS波系室性期前收缩(PVS),PVS后第1个心搏完全性右束支阻滞图形消失,T波由低平转倒置。 心电图诊断:①窦性心律;②完全性右束支阻滞;③PVS揭示3相右束支阻滞,慢性冠状动脉供血不足。     

血钾紊乱心电图异常及临床意义

目的总结血清钾离子紊乱的常见心电图异常并探讨其临床意义。方法回顾分析临床证实血清钾离子紊乱且有心电图异常的78例患者临床资料。结果 69例低血钾患者U波增高者56例,Q-T间期延长者54例,ST-T改变41例,T波改变46例,另有8例患者出现心律失常。9例高血钾患者中6例出现高尖、帐篷状T波改变,4例QRS波明显增宽,3例患者出现窦性心动过缓,1例发生窦-室传导。结论心电图可作为诊断血钾紊乱的重要辅助手段,帮助临床医师及时纠正血钾紊乱、避免血钾紊乱引起的各种严重心律失常。     

不同高压氧治疗方案对急性一氧化碳中毒受损心肌的疗效分析

目的 探讨不同高压氧(hyperbaric oxygen,HBO)治疗方案对急性一氧化碳(carbon monoxide,CO)中毒受损心肌的影响.方法 对2006年10月至2010年3月收治的155例重症CO中毒患者进行HBO常规治疗(常规组,75例)和HBO改进治疗(改进组,80例).(1)常规组治疗方案:治疗压力0.25 MPa,加压20 min,稳压后吸氧2次,每次30 min,中间间歇10 min,减压20 min出舱.每日1次,12次为1个疗程,治疗9-68次.(2)改进组方案:前5 d采用HBO常规治疗,以后采用减小治疗压力、缩短吸氧时间、增加吸氧间隔、间歇给氧的治疗方案,治疗压力0.20 MPa,稳压吸氧4次,每次10min,中间间歇5 min,减压20 min出舱.连续治疗3 d后间隔1 d,10 d为1个疗程.2组患者使用相同的药物治疗方案.统计分析常规组和改进组ST-T变化及血清心肌酶变化.结果 改进组与常规组相比ST-T恢复率(56%,28%)明显升高(P＜0.05),HBO治疗第3天和第6天ST-T加重率(第3天21%、25%.第6天16%、27%)明显降低(P＜0.01);2组血清心肌酶恢复率和加重率比较差异有统计学意义(P＜0.05.P＜0.01).结论 HBO改进方案对CO中毒患者受损心肌疗效较好.

Abstract：

Objective To investigate the effects of different hyperbaric oxygen ( HBO) treatment profiles on damaged myocardium induced by acute carbon monoxide poisoning. Methods One hundred and fifty-five serious cases of acute carbon monoxide ( CO) poisoning admitted into the hospital for treatment from October 2006 to March 2010 were randomly divided into the routine HBO treatment group (the routine group,75 cases) and the improved HBO treatment group (the improved group,80 cases). The treatment profile of the routine HBO treatment group: the patients were compressed for 20 min to the treatment pressure of 0.25 Mpa. Following stabilization at the said pressure, the patients breathed oxygen twice for 30 min plus 10 min, once a day. The whole treatment course consisted of 12 sessions, with the patients receiving HBO treatments from 9 to 68 times. The treatment profile of the improved HBO treatment group: the patients were given routine HBO treatment in the first 5 days, then, received improved HBO treatment, with a treatment profile of lower pressure (0.20 Mpa) , shorter oxygen-breathing time, lengthening of oxygen-breathing intervals and intermittent oxygen breathing. Total oxygen-breathing time was 4 times, each for 10 min plus 3 times each for 5 min. Then, the patients were decompressed to the surface following 20-min oxygen-breathing decompression. The patients received treatment for a succession of 3 days, then, had 1-day interval, and the whole treatment course consisted of 10 sessions. Changes in ST-T and myocardial enzymes of both the routine HBO treatment group and the improved HBO treatment group were measured and analyzed. Results ST-T recovery rate of the improved HBO treatment group increased (56% ,28% ) obviously, when compared with that of the routine HBO treatment group(P ＜ 0. 05). ST-T worse rate decreased significantly following HBO treatment on the 3rd and 6th days (21% and 25% on the 3rd day, 16% and 27% on the 6th day) respectively (P＜0.01). Statistical differences could be seen in the myocardial recovery rate and worse rate, when a comparison was made between them (P＜0. 05, P＜0. 01). Conclusions The improved HBO treatment profile showed better therapeutic effect on damaged myocardium induced by CO poisoning. This treatment profile should be used instead of other treatment profiles.     

不同高压氧治疗方案对急性一氧化碳中毒受损心肌的疗效分析

Objective To investigate the effects of different hyperbaric oxygen ( HBO) treatment profiles on damaged myocardium induced by acute carbon monoxide poisoning. Methods One hundred and fifty-five serious cases of acute carbon monoxide ( CO) poisoning admitted into the hospital for treatment from October 2006 to March 2010 were randomly divided into the routine HBO treatment group (the routine group,75 cases) and the improved HBO treatment group (the improved group,80 cases). The treatment profile of the routine HBO treatment group: the patients were compressed for 20 min to the treatment pressure of 0.25 Mpa. Following stabilization at the said pressure, the patients breathed oxygen twice for 30 min plus 10 min, once a day. The whole treatment course consisted of 12 sessions, with the patients receiving HBO treatments from 9 to 68 times. The treatment profile of the improved HBO treatment group: the patients were given routine HBO treatment in the first 5 days, then, received improved HBO treatment, with a treatment profile of lower pressure (0.20 Mpa) , shorter oxygen-breathing time, lengthening of oxygen-breathing intervals and intermittent oxygen breathing. Total oxygen-breathing time was 4 times, each for 10 min plus 3 times each for 5 min. Then, the patients were decompressed to the surface following 20-min oxygen-breathing decompression. The patients received treatment for a succession of 3 days, then, had 1-day interval, and the whole treatment course consisted of 10 sessions. Changes in ST-T and myocardial enzymes of both the routine HBO treatment group and the improved HBO treatment group were measured and analyzed. Results ST-T recovery rate of the improved HBO treatment group increased (56% ,28% ) obviously, when compared with that of the routine HBO treatment group(P ＜ 0. 05). ST-T worse rate decreased significantly following HBO treatment on the 3rd and 6th days (21% and 25% on the 3rd day, 16% and 27% on the 6th day) respectively (P＜0.01). Statistical differences could be seen in the myocardial recovery rate and worse rate, when a comparison was made between them (P＜0. 05, P＜0. 01). Conclusions The improved HBO treatment profile showed better therapeutic effect on damaged myocardium induced by CO poisoning. This treatment profile should be used instead of other treatment profiles.     

房性期前收缩揭示慢频率依赖性W—P—W综合征

1 心电资料 患者女,50岁。阵发性胸闷,心悸半年,临床诊断冠心病。于2000年4月26日来我院就诊做心电图,图A示V_5导联连续描记:基本节律为窦性,ORS波可分为2种形态:①1种为提前出现系PAS,P′-R>0.12s,ORS形态正常,其     

193例老年患者常规静息心电图ST-T改变与冠脉造影及超声心动图对比分析

目的 探讨老年患者静息心电图（ECG）慢性ST-T改变对冠心病的诊断价值.方法 对193例接受冠脉造影的非心梗老年患者的ECG资料进行分析,并将其与冠脉造影和超声心动图结果进比较.结果 冠脉造影确诊冠心病160例,其ECG ST-T改变阳性率为59.37%（95/160）,单支、双支及多支冠脉狭窄者阳性率分别为56.66%、60.41%、61.53%;ECG呈慢性ST-T改变者中90%（86/95）超声心动图示左室肥大、左房扩大或瓣膜钙化,49例超声心脏结构正常者ECG ST-T异常阳性率〈19%.结论 ECG慢性ST-T改变与左心室、左心房肥厚或扩张及瓣膜病变有重要关系,不能做为冠心病的确诊依据.     

起搏器间歇性心房感知不良致连续性心室安全期起搏1例

患者男,72岁,因病态窦房结综合征于当地医院植入DDD型心脏起搏器。起搏参数：DDD模式,基础频率60次／min、上限频率130／min,A·V间期180ms,非生理性A-V间期110ms,心房、心室不应期425／300ms,心房、心室起搏电压均为3．6V,起搏脉宽均为0．4ms,感知灵敏度为1．5／2．5mV,心室空白期为24ms。术后心电图示第1至第4个心房刺激脉冲分别落于P波顶点和降支,形成假性房性融合波,但第5、6个心房刺激脉冲落于P波后的PR段起始部,且起搏频率固定为60次／min,诊断为心房感知功能障碍;     

完全性左束支传导阻滞伴室性早搏QRS波正常化1例分析

图 1　ＣＬＢＢＢ伴ＰＶＳＱＲＳ正常化患者男 ,67岁。因胸闷、心悸伴心前区疼痛加重 3ｄ就诊。临床诊断 :冠心病。图示 :基本节律为窦性 ,心率 68次 ｍｉｎ ,Ｐ -Ｒ间期固定为 0 18ｓ,ＱＲＳ宽大畸形 0 14ｓ ,为完全性左束支传导阻滞 (ＣＬＢＢＢ)。但值得注意的是在Ⅲ及Ｖ2 导联可见提前与众相异的ＱＲＳ波 ,其前无Ｐ波 ,其ＱＲＳ波较窄为0 10ｓ ,原ＣＬＢＢＢ图形消失 ,考虑起搏点位于左束支阻滞部位以下 ,是室间隔部位发生的室性早搏 (ＰＶＳ) ,因其装置距离两侧束支大致相等 ,则在该处产生的异位激动由于沿两侧束支的正常传导系统同…