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目的:探讨心电图诊断高钾血症的临床价值。方法:对38例有高钾血症心电图表现的患者,结合其血清K+浓度进行对比分析。结果:心电图和实验室诊断符合率为89%,所有患者心电图表现为直立高耸的帐篷样T波,T波振幅的高低与血清K+浓度不呈平行关系,随着血清K+浓度增高,P波振幅降低或消失、P-R间期延长、QRS时限增宽、R波振幅减低、S波加深、ST段压低、QT间期延长、室内束支或分支传导阻滞,出现窦性心动过速2例,Ⅰ度房室传导阻滞1例,完全性右束支合并左前分支传导阻滞1例,窦室传导4例其中1例出现室性心动过速、心房扑动2∶1传导1例、心房颤动合并Ⅱ度房室传导阻滞1例。随着血清K+浓度的增加,T波改变的导联数越多。肾功能不全引起的高钾血症心电图表现与血清K+浓度有很好相关性;急性失血脱水所致的高钾血症其心电图改变较明显,而血清K+浓度值相对较低;细胞内外K+转移和细胞膜破坏K+释放入血所致的假性高钾血症,心电图表现较血清K+浓度更准确。结论:心电图诊断高钾血症方便、快捷,是临床急诊筛查高钾血症的有效方法。
Objective: To investigate the clinical value of electrocardiogram in the diagnosis of hyperkalemia. Methods: 38 cases of patients with hyperkalemia ECG, combined with serum K + concentration for comparative analysis. Results: The coincidence rate of electrocardiogram (ECG) and laboratory diagnosis was 89%. All the patients’ electrocardiogram showed high tenting tent wave. The amplitude of T wave was not parallel to serum K + concentration. With the increase of serum K + concentration, P wave amplitude Reduced or disappeared, prolonged PR interval, prolonged QRS duration, reduced R wave amplitude, S wave deepening, ST segment depression, QT interval prolongation, bundle branch or branch conduction indoors, sinus tachycardia occurred in 2 cases, Ⅰ degree atrioventricular block in 1 case, complete right bundle branch and left anterior branch block in 1 case, sinus ventricular conduction in 4 cases, 1 case of ventricular tachycardia, atrial flutter 2: 1 conduction in 1 case, atrial A case of tremor combined with second degree atrioventricular block. As the serum K + concentration increases, the more the T wave changes the number of leads. Hypokalemia due to renal insufficiency caused by electrocardiogram and serum K + concentration has a good correlation; acute dehydration caused by hyperkalemia electrocardiogram changes more obvious, while the serum K + concentration is relatively low; intracellular K + transfer And cell membrane destruction K + release into the blood caused by pseudo-hyperkalemia, ECG performance more accurate than serum K + concentration. Conclusion: ECG diagnosis of hyperkalemia is convenient and quick, and it is an effective method for clinical screening of hyperkalemia.