血液透析对尿毒症高钾患者心电图的影响  

The Influence of Electrocardiogram on Patients with Uremia and Hyperkalemia by Hemodialysis

作　　者：杨学娜[1] 孙洞箫[1] 刘仁光[1] 

机构地区：[1]辽宁医学院附属第一医院,辽宁锦州121001

出　　处：《辽宁医学院学报》2011年第4期360-362,I0004,共4页Journal of Liaoning Medical University (LNMU) Bimonthly

摘　　要：目的观察尿毒症高钾血症患者(K+≥6.5 mmol/L)血液透析前后不同钾离子浓度对应心电图变化。方法选择我院肾内科住院并行血液透析的尿毒症并高钾血症(K+≥6.5 mmol/L)患者20例,观测:1.血液透析前后血清钾浓度;2.心电图:透析前后心电图P波振幅、PR间期、QRS时间、T波振幅和QT间期。结果 1.血液透析后,20例患者血清钾浓度均降至正常范围。2.心电图:(1)P波振幅:透析前19例降低,1例P波消失,透析后全部恢复正常,差异有显著统计学意义;(2)透析前PR间期、QRS时间延长、T波振幅增大,透析后恢复正常,差异均有显著统计学意义;(3)QT间期:透析前18例在正常范围,2例延长,均值为(0.423±0.078)s,透析后QT间期为(0.407±0.035)s,差异有统计学意义(P<0.05)。结论进一步证实高钾常见心电图改变:T波增高,P波降低至P波消失(形成窦室传导),房室阻滞、室内阻滞(非特异性QRS增宽)。血液透析可迅速降低血钾,使心电图恢复。Objective To observe the changes of electrocardiogram of patients who suffer from uremia and hyperkalemia （ K ^＋ ≥6. 5 retool/L） according to the different concentrations of potassium before and ＇after hemodialysis. Method Twenty patients with uremia and hyperkalemia （ K^＋≥6.5 mmol/L ） were chosen to take part in the experimenh They were in hospital and received hemodialysis in department of nephrology. The measures were coneentrations of potassium, amplitudes of P waves, PR intervals, the time of QRS waves, amplitudes of T waves and QT intervals of ECGs before arid after hemodialysis. Result 1. The concentration of potassimn of 20 patients all reduced to the normal range. 2. ECGs： （ 1 ） The amplitudes of P waves （ 19 cases 3 were returned to the normal state. Moreover, the P wave disappeared in the first case heft）re hemodialysis. （2） The PR intervals and the time of QRSs prolonged and the amplitudes of T waves increased before hemodialysis, which turned to the normal state alter hemodialysis and had shown significant statistical differences （ P 〈 0. 01 ）. （3） The QT intervals of 18 cases were in the normal range and 2 of them prolonged compared with the normal level, the mean was significantly shortened from （ 0. 423 ± 0. 078） to （ 0. 407 ±0. 035 ） s after hemodialysis. Conclusion This study further confirmed that the common changes of hyperkalemia＇ ECGs （ K^＋ ≥6. 5 mmol/L ） were as follows ： the amplitudes of T waves increased; widespread atrial myocardium blocked and sinoventricular conduction usually could be seen in patients with severe hyperkalemia; atrioventrieular block and non -specific wide QRS became the important evidences of severe hyperkalemia. The concentration of potassium could be reduced significantly by hemodialysis. It also can make the electrocardiogram recover.

关 键 词：心电图 高钾血症 尿毒症 血液透析 

分 类 号：R540.4[医药卫生—心血管疾病]