CAJ | 학술논문

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。
목적：관측신공능불전고갑환자혈액투석전、후수혈청갑리자농도변화대응적심전도변화특점，위림상고갑혈증진단제공선색。방법선택아원50례진단위신공능불전병고갑혈증진행혈액투석적환자，관측：（1）혈액투석전、후혈청갑리자농도；（2）심전도：혈액투석전후심솔、 P파시한、 PR간기、 QRS시한、 T파진폭、 T파시한、 QT간기。결과（1）투석전T파시한교투석후축단（145.20±23.49） ms vs （180.00±22.86） ms，진폭교투석후증대（0.76±0.54） mV vs （0.43±0.36） mV，균P＜0.05，차수착혈갑증고T파고첨정도증가；（2）투석전P파시한、 PR간기화QRS시한균교투석후연장（112.50±15.33） ms vs （98.80±14.88） ms、（175.98±35.40） ms vs （157.34±22.73） ms화（104.00±20.85） ms vs （88.76±10.39） ms，균P＜0.05，저사개변주요출현재중、중도고갑병례병수착혈갑농도증가이가중。결론진일보증실T파증고시고갑최선출현、상견적심전도표현；방내조체（ P파증관지소실）、실내조체（ QRS증관）화방실조체시중、중도고갑적심전도표현。
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.