本文關(guān)鍵詞： 支氣管肺泡灌洗術(shù) 兒童 心電圖 心臟電生理　出處：《大連醫(yī)科大學(xué)》2012年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的：通過(guò)對(duì)急性重度肺炎患兒行支氣管肺泡灌洗術(shù)的不同環(huán)節(jié)進(jìn)行心電圖的監(jiān)測(cè)，探討支氣管肺泡灌洗術(shù)對(duì)重度肺炎患兒心電指標(biāo)的影響，從心臟電生理角度佐證急性重度肺炎患兒行支氣管肺泡灌洗術(shù)的安全性。 方法：采用前瞻性、連續(xù)采樣的方法，選擇符合納入標(biāo)準(zhǔn)的2011年7月～2012年3月于我院呼吸科住院、年齡3歲至12歲、診斷為重度肺炎、無(wú)其它系統(tǒng)基礎(chǔ)疾病并行支氣管肺泡灌洗術(shù)的患兒。術(shù)前行常規(guī)檢查，排除心電圖異常、既往患先天性心臟病、各種類(lèi)型心肌病、各種原因引起的心肌炎及心肌損害、各種原因引起的心包疾病、心律失常、有心臟手術(shù)史、營(yíng)養(yǎng)不良、自主呼吸不能維持氧合，需要呼吸機(jī)行呼吸支持、合并心衰及腦病、肌酸激酶同工酶（CK-MB）及肌鈣蛋白檢測(cè)高于正常、電解質(zhì)紊亂、3天內(nèi)應(yīng)用過(guò)抗心律失常藥物及洋地黃類(lèi)藥物的患者。在支氣管肺泡灌洗術(shù)前、麻醉、入聲門(mén)、注液、吸引、蘇醒等環(huán)節(jié)進(jìn)行心電圖檢查，并測(cè)量心電圖的心率、節(jié)律、P波振幅及寬度、PR間期、QRS波形態(tài)及寬度、QTC（校正QT間期）、ST段、T波、U波等各項(xiàng)指標(biāo)，同時(shí)記錄血氧飽和度及并發(fā)癥情況。對(duì)所記錄數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果： 1.一般情況：符合納入標(biāo)準(zhǔn)的患者30例，平均年齡5.3歲，男:女為1.3:1；對(duì)全部30人次進(jìn)行了術(shù)前及操作過(guò)程中的心電圖描記，無(wú)數(shù)據(jù)缺失。 2.支氣管肺泡灌洗術(shù)不同環(huán)節(jié)對(duì)各心電指標(biāo)的影響： ①支氣管肺泡灌洗術(shù)操作過(guò)程中除P波及U波外，，心率、節(jié)律、PR間期、QRS波、QT間期等各項(xiàng)心電圖指標(biāo)均可出現(xiàn)異常； ②心率增快最多見(jiàn)，均為竇性心動(dòng)過(guò)速，以注液及蘇醒時(shí)增快最明顯； ③入聲門(mén)、注液及吸引時(shí)出現(xiàn)心律失常，多為單發(fā)早搏，氣管內(nèi)操作結(jié)束后未記錄到心律失常； ④入聲門(mén)過(guò)程中有2例患者發(fā)生惡性心律失常，近半數(shù)心律失常伴隨低氧血癥出現(xiàn)； ⑤QRS波可見(jiàn)電壓交替現(xiàn)象及不完全性右束支傳導(dǎo)阻滯，注液操作對(duì)QRS波影響最大； ⑥QTC可出現(xiàn)異常，但異常率不高，麻醉、入聲門(mén)、麻醉蘇醒環(huán)節(jié)均可以出現(xiàn)QT間期延長(zhǎng)，但異常率無(wú)明顯差異； ⑦ST-T改變較多見(jiàn)，但多為單獨(dú)出現(xiàn)的ST改變或T波改變，病理意義不大，僅1名患者出現(xiàn)ST段下移同時(shí)伴有同導(dǎo)聯(lián)T波異常； 3.氣管肺泡灌洗術(shù)各個(gè)操作環(huán)節(jié)下心電圖測(cè)量值異常率的比較： ①不同的操作環(huán)節(jié)對(duì)心電圖各個(gè)測(cè)量值的影響不完全一致，但以對(duì)心率及T波的影響最顯著； ②注液操作對(duì)QRS波的影響最明顯； 4.不同進(jìn)鏡次數(shù)對(duì)入聲門(mén)環(huán)節(jié)心電指標(biāo)影響的差異比較：多次進(jìn)鏡組和一次進(jìn)鏡組入聲門(mén)時(shí)心電圖的異常率無(wú)顯著差異，但惡性心律失常均發(fā)生在多次進(jìn)鏡組。 結(jié)論： ①支氣管肺泡灌洗術(shù)對(duì)心電生理有影響，但影響不大，持續(xù)時(shí)間不長(zhǎng)。 ②從心電生理角度來(lái)看，支氣管肺泡灌洗術(shù)的安全性可以得到保證。
[Abstract]:Objective: to investigate the effect of bronchoalveolar lavage on electrocardiogram (ECG) in children with severe pneumonia by monitoring different aspects of bronchoalveolar lavage. The safety of bronchoalveolar lavage in children with severe acute pneumonia was confirmed by cardiac electrophysiology. Methods: a prospective and continuous sampling method was used. The patients, aged from 3 to 12 years, who were hospitalized in respiratory department from July 2011 to March 2012, were diagnosed as severe pneumonia. Children with no other systemic diseases and bronchoalveolar lavage. Routine examination was performed before operation to exclude abnormal electrocardiogram, congenital heart disease, various types of cardiomyopathy, myocarditis caused by various causes and myocardial damage. Pericardial diseases caused by various causes, arrhythmia, history of heart surgery, malnutrition, inability to maintain oxygenation by autonomic breathing, respiratory support by ventilator, heart failure and encephalopathy, Creatine kinase isoenzyme (CK-MBB) and cardiac troponin were detected higher than normal, electrolyte disturbance patients were treated with antiarrhythmic drugs and digitalis drugs within 3 days. Before bronchoalveolar lavage, anesthesia, glottis, fluid injection, suction, ECG examination was carried out in the wake of patients, and the heart rate, amplitude and width of P wave in ECG, the shape and width of QRS wave during PR interval, and so on were measured, so as to correct the T wave U wave in St segment during QT interval, and so on. Blood oxygen saturation and complications were recorded. The recorded data were analyzed statistically. Results:. 1. General conditions: 30 patients (mean age 5.3 years, male: female: 1.3: 1) met the inclusion criteria. Electrocardiograms were performed on all 30 patients before and during operation, and no data were missing. 2. The effect of different aspects of bronchoalveolar lavage on ECG:. (1) in the course of bronchoalveolar lavage, the ECG parameters such as P wave and U wave, heart rate and QRS wave QT interval were abnormal. 2the heart rate increased most frequently, all of them were sinus tachycardia. (3) Arrhythmia occurred when entering the acoustics, injecting liquid and attracting, most of them were single premature beats, but no arrhythmia was recorded after trachea operation. (4) malignant arrhythmias occurred in 2 patients, and nearly half of them were accompanied by hypoxemia. 5The visible voltage alternation of QRS wave and incomplete right bundle branch block were observed, and the effect of liquid injection on QRS wave was the greatest. 6QTC may appear abnormal, but the abnormal rate is not high, anesthesia, entrance door, anaesthesia recovery link can appear QT interval to prolong, but the abnormal rate has no obvious difference; 7ST-T changes were more common, but most of them were single St changes or T wave changes, and the pathological significance was not significant. Only one patient had St segment depression and accompanied with abnormal T wave in the same lead. 3. Comparison of abnormal rate of electrocardiogram (ECG) measurement in each operation of tracheoalveolar lavage:. (1) the effects of different operation links on ECG measurements were not completely consistent, but the effects on heart rate and T wave were the most significant. (2) the effect of liquid injection operation on QRS wave is the most obvious; 4. Comparison of the effects of different times of entry on ECG parameters: there was no significant difference in the abnormal rate of electrocardiogram between the multiple access group and the single access group, but malignant arrhythmia occurred in the multiple access group. Conclusion:. 1 bronchoalveolar lavage had an effect on electrocardiology, but it had little effect and did not last for a long time. 2 from the electrophysiological point of view, the safety of bronchoalveolar lavage can be guaranteed.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類(lèi)號(hào)】：R725.6

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