輔助檢查心電圖課件

輔助檢查心電圖ppt課件匯報(bào)人：xxx20xx-03-15REPORTING目錄心電圖基本概念與原理正常心電圖表現(xiàn)及判讀方法心臟疾病在心電圖上表現(xiàn)特征輔助檢查技巧與注意事項(xiàng)案例分析與實(shí)踐操作演示總結(jié)回顧與展望未來(lái)發(fā)展趨勢(shì)PART01心電圖基本概念與原理REPORTINGlogo利用心電圖機(jī)從體表記錄心臟每一心動(dòng)周期所產(chǎn)生的電活動(dòng)變化圖形的技術(shù)。用于診斷心律失常、心肌缺血/梗死、房室肥大或電解質(zhì)紊亂等心臟相關(guān)疾病，是臨床最常用的檢查之一。心電圖定義及作用心電圖作用心電圖（ECG）定義心肌細(xì)胞在靜息狀態(tài)下存在穩(wěn)定的靜息電位，當(dāng)受到刺激時(shí)，會(huì)發(fā)生去極化、復(fù)極化等電生理過(guò)程。心肌細(xì)胞的電活動(dòng)心臟電信號(hào)通過(guò)心臟傳導(dǎo)系統(tǒng)（包括竇房結(jié)、結(jié)間束、房室結(jié)等）進(jìn)行傳導(dǎo)，使心臟各部分協(xié)調(diào)收縮。心臟電信號(hào)的傳導(dǎo)心臟電生理基礎(chǔ)以下附贈(zèng)各項(xiàng)管理制度英文版（不需要可刪）急救藥品、器材管理制度:1.Rescuedrugsandequipmentshouldbe"fivefixed"(fixedquantityandvariety,designatedplacement,designatedpersonstorage,regulardisinfectionandsterilization,regularinspectionandmaintenance)and"twotimely"(timelyinspectionandmaintenance,timelyreceiptandsupplementation).Theitemisclearlymarkedandcannotbeusedarbitrarily.2.Thenecessaryrescueequipmentiscomplete,ingoodperformance,andinstandbycondition.3.Therescuedrugsarecomplete,withcleardruglabelsandnodiscoloration,deterioration,expiration,ordamage.Theyshouldbeplacedandusedintheorderofdrugexpirationdates(fromrighttoleft).4.Emergencydrugsanditemsforeachdepartment'srescuevehicleshallbeuniformlyequippedaccordingtorequirements.Specializedemergencydrugsanditemsmustbereviewedandapprovedbythedepartmentdirectortodeterminethetype,quantity,specifications,anddosagetobeequipped.Rescuevehiclesmustbeplacedindesignatedlocationsandmanagedbydesignatedpersonneltoensuresafetyandeaseofuse.5.Afterusingrescuedrugsandequipment,theyshouldbefullyreplenishedwithin24hours.Iftheycannotbereplenishedduetospecialreasons,theyshouldbenotedonthehandoverregistrationformandreportedtotheheadnurseforcoordinationandresolutiontoensuretimelyuseduringpatientrescue.6.Thereisaregistrationbookfortheprovisionofdrugsandequipment.Ensureconsistencybetweenaccountsandmaterials,andhandoverbetweenshifts.7.Managementofsealedrescuevehicles:Beforesealing,theheadnurse(ornurseincharge)andanothernurseshallcountthedrugsandequipmentaccordingtotheregistrationbookofdrugandequipmentequipment,verifytheiraccuracy,andsealthemwithaseal.Twopeopleshallsignandfillinthesealingtime.Nurseschecktheconditionofthesealsoncepershiftandcompletethehandover.Theresponsiblenursescheckonceaweek,andtheheadnurseandresponsiblenursesopenthesealsandinspectthedrugsandequipmentintheambulanceonceamonth,withrecordskept.8.Nonsealedrescuevehiclemanagement:Eachshiftshallcountthedrugsandequipmentaccordingtotheregistrationbookandcompletethehandover.Theresponsiblenurseshallinspectonceaweek,andtheheadnurseshallinspectonceeverytwoweeksandkeeprecords,ensuringthattheaccountsmatchthematerials.護(hù)理文書書寫制度:

1.Nursingstaffstrictlyfollowthelatestrequirementswhenwritingnursingmedicalrecords.2.Thecontentofnursingrecordsshouldbeobjective,truthful,accurate,timely,complete,andstandardized.3.Allnursingdocumentsshouldbewrittenwithablueblackorcarboninkpen.4.AllnursingdocumentsshouldbewritteninArabicnumeralsfordateandtime,withdatesinyears,months,anddays,usinga24-hoursystem,specifictominutes.5.WritingshoulduseChinese,medicalterminology,andcommonlyusedforeignlanguageabbreviations;Completerecorditems;Thetextisneat,thehandwritingisclear,andthelayoutisclean;Accurateexpression,fluentsentences,simpleandconcise:correctformatandpunctuation,notypos.6.Whenerrorsoccurduringthewritingprocess,doublelinethemonthewrongwords,keeptheoriginalrecordclearanddistinguishable,signthemodifier,indicatethemodificationtime,continuetowritethecorrectcontent,anddonotusescraping,sticking,paintingorothermethodstocoveruporremovetheoriginalhandwriting.Eachpageshouldbemodifiednomorethantwotimes,otherwisetheoriginalrecorderwillpromptlycopyagain(exceptformodificationsmadebysuperiors).7.Nursingrecordswrittenbyinternnurses,probationarynurses,orunregisterednursesshouldbereviewedandsignedbynurseswithlegalprofessionalqualificationsinthismedicalinstitution.8.Furthertrainingnursescanonlywritenursingdocumentsafterbeingrecognizedbythemedicalinstitutionreceivingthetrainingfortheirworkability.9.Superiornursingstaffhavetheresponsibilitytoreviewandmodifythewrittenrecordsofsubordinatenursingstaff.Whenmakingmodifications,reddoublelinesshouldbeusedtomarkerrors,writethemodifiedcontent,signandindicatethemodificationtime.10.Temperaturerecords,medicalorders,patientcarerecords,andsurgicalinventoryrecordsshouldbearchivedontime.P波QRS波群T波U波心電圖波形組成與意義01020304代表心房除極的電位變化，形態(tài)通常為圓鈍形。代表心室除極的電位變化，形態(tài)因?qū)?lián)不同而有所差異。代表心室復(fù)極的電位變化，方向與QRS波群主波方向一致?？赡芘c心室復(fù)極后電位變化有關(guān)，但具體意義尚不完全明確。標(biāo)準(zhǔn)導(dǎo)聯(lián)加壓?jiǎn)螛O肢體導(dǎo)聯(lián)胸導(dǎo)聯(lián)其他導(dǎo)聯(lián)心電圖導(dǎo)聯(lián)體系介紹包括I、II、III導(dǎo)聯(lián)，用于記錄兩個(gè)肢體之間的電位差。包括V1-V6導(dǎo)聯(lián)，用于記錄胸部不同位置的電位變化。包括aVR、aVL、aVF導(dǎo)聯(lián)，用于記錄單個(gè)肢體與加壓中心電端之間的電位差。如右胸導(dǎo)聯(lián)、后壁導(dǎo)聯(lián)等，可根據(jù)臨床需要選擇使用。PART02正常心電圖表現(xiàn)及判讀方法REPORTINGlogo通常成人在安靜狀態(tài)下心率為60-100次/分鐘，兒童心率較快，老年人和運(yùn)動(dòng)員心率較慢。正常心率范圍正常心電圖的節(jié)律應(yīng)該是規(guī)則的，即R-R間期應(yīng)該相等。節(jié)律規(guī)則性正常心率范圍與節(jié)律規(guī)則性代表心房除極的電位變化，形態(tài)一般呈鈍圓形，時(shí)限小于0.12秒。P波代表心室除極的電位變化，正常形態(tài)因?qū)?lián)不同而有所差異，但一般時(shí)限在0.06-0.10秒之間。QRS波群代表心室復(fù)極的電位變化，形態(tài)一般較圓鈍，時(shí)限較長(zhǎng)，與QRS波群主波方向一致。T波是T波后的小波，方向與T波相同，時(shí)限較短。U波各波段正常形態(tài)與時(shí)限要求ST段改變ST段壓低可能提示心肌缺血，ST段抬高可能提示心肌梗死或心包炎等。T波改變T波低平或倒置可能提示心肌缺血、心肌病、電解質(zhì)紊亂等，T波高聳可能提示心肌梗死超急性期或高鉀血癥等。ST-T改變及其臨床意義常見異常心電圖類型識(shí)別包括竇性心動(dòng)過(guò)速、竇性心動(dòng)過(guò)緩、房性期前收縮、室性期前收縮等。包括房室傳導(dǎo)阻滯、室內(nèi)傳導(dǎo)阻滯等。典型表現(xiàn)為ST段抬高和T波改變，結(jié)合臨床癥狀和心肌酶學(xué)檢查可確診。如高鉀血癥、低鉀血癥等，可通過(guò)心電圖表現(xiàn)結(jié)合血電解質(zhì)檢查進(jìn)行診斷。心律失常傳導(dǎo)阻滯心肌梗死電解質(zhì)紊亂PART03心臟疾病在心電圖上表現(xiàn)特征REPORTINGlogo典型表現(xiàn)ST段壓低、T波低平或倒置，反映心肌缺血；有時(shí)可見心律失常表現(xiàn)。診斷要點(diǎn)結(jié)合患者年齡、性別、臨床癥狀及心電圖改變，可初步診斷；確診需進(jìn)一步行冠狀動(dòng)脈造影等檢查。冠狀動(dòng)脈粥樣硬化性心臟病心肌梗死典型表現(xiàn)ST段抬高呈弓背向上型，病理性Q波，T波倒置；心電圖動(dòng)態(tài)演變過(guò)程。診斷要點(diǎn)根據(jù)典型心電圖改變、心肌酶學(xué)改變及臨床表現(xiàn)，可作出診斷；需與心絞痛、急性心包炎等鑒別。VS包括竇性心律失常、房性心律失常、房室交界區(qū)性心律失常、室性心律失常等。診斷依據(jù)根據(jù)心電圖上P波、QRS波群形態(tài)、時(shí)限、頻率等特征，結(jié)合患者臨床表現(xiàn)，可作出診斷。心律失常分類心律失常分類及診斷依據(jù)心肌病心肌炎心臟瓣膜病心包疾病其他類型心臟疾病在心電圖上表現(xiàn)可見心室肥大、ST-T改變、異常Q波、心律失常等。常見ST-T改變、竇性心動(dòng)過(guò)速、房室傳導(dǎo)阻滯、期前收縮等。可見心房顫動(dòng)、房室傳導(dǎo)阻滯、室性期前收縮等；結(jié)合心臟聽診及超聲心動(dòng)圖檢查可作出診斷。急性心包炎可見廣泛導(dǎo)聯(lián)ST段弓背向下抬高，aVR及V1導(dǎo)聯(lián)ST段壓低；慢性縮窄性心包炎可見QRS波群低電壓、T波平坦或倒置等。PART04輔助檢查技巧與注意事項(xiàng)REPORTINGlogo清潔皮膚，降低皮膚阻抗，以獲得更清晰的信號(hào)。必要時(shí)可以輕微打磨皮膚，但避免破損。皮膚準(zhǔn)備導(dǎo)聯(lián)線連接使用合適的電極確保電極與皮膚緊密接觸，導(dǎo)聯(lián)線正確連接，避免松動(dòng)或接觸不良導(dǎo)致信號(hào)干擾。根據(jù)檢查需要選擇合適的電極，如一次性電極或可重復(fù)使用電極，確保電極質(zhì)量良好。030201采集優(yōu)質(zhì)信號(hào)：皮膚準(zhǔn)備、導(dǎo)聯(lián)線連接等避免干擾因素：肌肉活動(dòng)、交流電源等減少肌肉活動(dòng)指導(dǎo)患者放松肌肉，避免緊張或運(yùn)動(dòng)導(dǎo)致肌電干擾。必要時(shí)可以使用鎮(zhèn)靜劑。遠(yuǎn)離交流電源避免心電圖機(jī)與交流電源過(guò)近，減少電磁干擾。同時(shí)確保心電圖機(jī)接地良好。避免其他電子設(shè)備干擾如手機(jī)、無(wú)線電話等，應(yīng)遠(yuǎn)離心電圖檢查區(qū)域，避免產(chǎn)生干擾信號(hào)。導(dǎo)聯(lián)選擇根據(jù)需要選擇合適的導(dǎo)聯(lián)進(jìn)行記錄。常規(guī)心電圖通常選擇12個(gè)導(dǎo)聯(lián)，必要時(shí)可增加導(dǎo)聯(lián)數(shù)。記錄時(shí)間長(zhǎng)度根據(jù)需要確定記錄時(shí)間長(zhǎng)度。對(duì)于疑似心律失?；颊?，應(yīng)適當(dāng)延長(zhǎng)記錄時(shí)間，以便捕捉到異常心電信號(hào)。正確選擇導(dǎo)聯(lián)和記錄時(shí)間長(zhǎng)度在解讀心電圖前，應(yīng)了解患者的病史、癥狀、體征等信息，以便更好地理解心電圖表現(xiàn)。了解患者病史將心電圖與其他檢查結(jié)果（如超聲心動(dòng)圖、X線等）進(jìn)行綜合分析，提高診斷準(zhǔn)確性。結(jié)合其他檢查結(jié)果對(duì)于疑似心臟疾病患者，應(yīng)定期復(fù)查心電圖，關(guān)注動(dòng)態(tài)變化，以便及時(shí)發(fā)現(xiàn)并處理問題。注意動(dòng)態(tài)變化結(jié)合臨床信息進(jìn)行綜合判斷PART05案例分析與實(shí)踐操作演示REPORTINGlogoP波、QRS波群、T波等波形特征明顯，心率、心律規(guī)整，無(wú)異常改變。正常心電圖特點(diǎn)包括心律失常、心肌缺血、心肌梗死等多種類型，波形特征各異，需要結(jié)合臨床進(jìn)行診斷。異常心電圖類型通過(guò)實(shí)際案例展示正常和異常心電圖，詳細(xì)解讀波形特征和臨床意義，提高學(xué)員識(shí)別能力。案例展示與解讀典型案例分析：正常和異常心電圖對(duì)比03心電圖分