肾功能不全高钾患者透析前、后心电图分析  

Electrocardiographic Analysis of Hyperkalemia in Renal Insufficiency Patients on Pre-and Post—Hemodialysis

作　　者：陈娟[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》2014年第2期72-75,共4页Journal of Liaoning Medical University (LNMU) Bimonthly

摘　　要：目的观测肾功能不全高钾患者血液透析前、后随血清钾离子浓度变化对应的心电图变化特点,为临床高钾血症诊断提供线索。方法选择我院50例诊断为肾功能不全并高钾血症进行血液透析的患者,观测:(1)血液透析前、后血清钾离子浓度;(2)心电图:血液透析前后心率、P波时限、PR间期、QRS时限、T波振幅、T波时限、QT间期。结果(1)透析前T波时限较透析后缩短(145.20±23.49)ms vs(180.00±22.86)ms,振幅较透析后增大(0.76±0.54)mV vs(0.43±0.36)mV,均P<0.05,且随着血钾增高T波高尖程度增加;(2)透析前p波时限、PR间期和QRS时限均较透析后延长(112.50±15.33)ms vs(98.80±14.88)ms、(175.98±35.40)ms vs(157.34±22.73)ms和(104.00±20.85)ms vs(88.76±10.39)ms,均P<0.05,这些改变主要出现在中、重度高钾病例并随着血钾浓度增加而加重。结论进一步证实T波增高是高钾最先出现、常见的心电图表现;房内阻滞(P波增宽至消失)、室内阻滞(QRS增宽)和房室阻滞是中、重度高钾的心电图表现。Objective To observe the corresponding different electrocardiogram （ECG） manifestations with changes of serum po-tassium levels in patients with renal insufficiency and hyperkalemia on pre-and post-hemodialysis （ HD） , providing diagnostic clues of hyperkalemia for the clinicians .Method A total of 50 cases of patients with renal insufficiency and hyperkalemia receiving hemodi-alysis in our hospital were selected.This study was preformed to evaluate the parameters such as serum potassium concentration and electrocardiographic findings including such factors as heart rate, P duration, PR interval, QRS duration, T amplitude and duration and QT intervals on pre-and post-hemodialysis respectively.Results （1） T wave duration on pre-HD was shorter than the post-HD （145.20±23.49 ） ms vs （180.00±22.86 ） ms and the T wave amplitude on pre-HD was increased compared with the post-HD （0.76±0.54） mV vs （0.43±0.36） mV （P〈0.05）.Peaked and narrow-based T waves are progressively increased according to the level of the serum potassium elevation.（2） P waves duration, PR interval and QRS complex duration on pre-HD were all more pro-longed than on the post-HD, （112.50±15.33） ms vs （98.80±14.88） ms, （175.98±35.40） ms vs （157.34±22.73） ms and （104.00±20.85） ms vs （88.76±10.39） ms respectively, P〈0.05.Furthermore, these ECG changes mainly appear in the moderate and severe hyperkalemia , obviously consistent with the increased level of serum potassium.Conclusion This study further confirmed that the peaked T wave is the most common and the earliest manifestations on the ECG associated with hyperkalemia .Other electrocar-diogram manifestations in patients with moderate and severe hyperkalemia include intra-atrium block （ progressive prolonged P wave duration until flat）, intraventricular block （wide QRS complex） and atrioventricular block.

关 键 词：心电图 高钾血症 血液透析 肾功能不全 

分 类 号：R540.4[医药卫生—心血管疾病]