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NEJM:体温过低所致的心电图改变-病例报道

2018-02-01 xing.T MedSci原创

低温诱导的心肌瞬时外向钾电流活动的增加,其中在心外膜较心内膜更为突出。这种非均匀分布的钾电流所致的J波,通常主要在下壁及侧胸导联中能够观察到,正如该患者一样。J波的大小通常与低温程度有关。除了低温,J波已经可以发生在常温下相关疾病状态(如高钙血症、Brugada综合征和神经损伤)。

患者为一名76岁的女性,既往有痴呆和冠心病病史,因在户外摔倒无意识而被送到急诊就诊,

该患者就诊时核心体温为26°C(78.8华氏度)。心电图显示明显的奥斯本波,也称为J波(如图A箭头所示),伴随QRS持续时间延长和校正QT间期。实验室检查显示血清钾水平为5.7mmol/L(参考范围为3.5-4.6)、肌酸激酶水平为1230U/L(参考范围为25-190),血清pH值为7.19。血钙水平正常。



低温诱导的心肌瞬时外向钾电流活动的增加,其中在心外膜较心内膜更为突出。这种非均匀分布的钾电流所致的J波,通常主要在下壁及侧胸导联中能够观察到,正如该患者一样。J波的大小通常与低温程度有关。除了低温,J波已经可以发生在常温下相关疾病状态(如高钙血症、Brugada综合征和神经损伤)。

该病人复苏后12小时,J波消失、QT间期和QRS时限正常(如图B所示)。

原始出处:

Eleftheria Kampouri, et al. Electrocardiographic Changes in Hypothermia.N Engl J Med 2018. http://www.nejm.org/doi/full/10.1056/NEJMicm1704534

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  2. [GetPortalCommentsPageByObjectIdResponse(id=1771402, encodeId=e87a1e7140290, content=<a href='/topic/show?id=815526629e9' target=_blank style='color:#2F92EE;'>#体温过低#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26629, encryptionId=815526629e9, topicName=体温过低)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7d2138274719, createdName=lmm410, createdTime=Sun Jul 22 03:55:00 CST 2018, time=2018-07-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=287253, encodeId=748128e2530d, content=体温与心脏往往容易忽视, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=76802018286, createdName=元元maple, createdTime=Mon Feb 12 06:52:48 CST 2018, time=2018-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=284114, encodeId=e053284114be, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Thu Feb 01 08:59:07 CST 2018, time=2018-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=284107, encodeId=74d428410e5f, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Thu Feb 01 08:19:18 CST 2018, time=2018-02-01, status=1, ipAttribution=)]
    2018-02-12 元元maple

    体温与心脏往往容易忽视

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1771402, encodeId=e87a1e7140290, content=<a href='/topic/show?id=815526629e9' target=_blank style='color:#2F92EE;'>#体温过低#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26629, encryptionId=815526629e9, topicName=体温过低)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7d2138274719, createdName=lmm410, createdTime=Sun Jul 22 03:55:00 CST 2018, time=2018-07-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=287253, encodeId=748128e2530d, content=体温与心脏往往容易忽视, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=76802018286, createdName=元元maple, createdTime=Mon Feb 12 06:52:48 CST 2018, time=2018-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=284114, encodeId=e053284114be, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Thu Feb 01 08:59:07 CST 2018, time=2018-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=284107, encodeId=74d428410e5f, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Thu Feb 01 08:19:18 CST 2018, time=2018-02-01, status=1, ipAttribution=)]
    2018-02-01 明月清辉

    谢谢分享.学习了

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1771402, encodeId=e87a1e7140290, content=<a href='/topic/show?id=815526629e9' target=_blank style='color:#2F92EE;'>#体温过低#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26629, encryptionId=815526629e9, topicName=体温过低)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7d2138274719, createdName=lmm410, createdTime=Sun Jul 22 03:55:00 CST 2018, time=2018-07-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=287253, encodeId=748128e2530d, content=体温与心脏往往容易忽视, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=76802018286, createdName=元元maple, createdTime=Mon Feb 12 06:52:48 CST 2018, time=2018-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=284114, encodeId=e053284114be, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Thu Feb 01 08:59:07 CST 2018, time=2018-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=284107, encodeId=74d428410e5f, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Thu Feb 01 08:19:18 CST 2018, time=2018-02-01, status=1, ipAttribution=)]
    2018-02-01 Y—xianghai

    学习了新知识

    0

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