支气管肺泡灌洗术对重度肺炎患儿心电指标影响的研究

发布时间：2018-02-23 03:57

本文关键词： 支气管肺泡灌洗术儿童心电图心脏电生理　出处：《大连医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的：通过对急性重度肺炎患儿行支气管肺泡灌洗术的不同环节进行心电图的监测，探讨支气管肺泡灌洗术对重度肺炎患儿心电指标的影响，从心脏电生理角度佐证急性重度肺炎患儿行支气管肺泡灌洗术的安全性。方法：采用前瞻性、连续采样的方法，选择符合纳入标准的2011年7月～2012年3月于我院呼吸科住院、年龄3岁至12岁、诊断为重度肺炎、无其它系统基础疾病并行支气管肺泡灌洗术的患儿。术前行常规检查，排除心电图异常、既往患先天性心脏病、各种类型心肌病、各种原因引起的心肌炎及心肌损害、各种原因引起的心包疾病、心律失常、有心脏手术史、营养不良、自主呼吸不能维持氧合，需要呼吸机行呼吸支持、合并心衰及脑病、肌酸激酶同工酶（CK-MB）及肌钙蛋白检测高于正常、电解质紊乱、3天内应用过抗心律失常药物及洋地黄类药物的患者。在支气管肺泡灌洗术前、麻醉、入声门、注液、吸引、苏醒等环节进行心电图检查，并测量心电图的心率、节律、P波振幅及宽度、PR间期、QRS波形态及宽度、QTC（校正QT间期）、ST段、T波、U波等各项指标，同时记录血氧饱和度及并发症情况。对所记录数据进行统计学分析。结果： 1.一般情况：符合纳入标准的患者30例，平均年龄5.3岁，男:女为1.3:1；对全部30人次进行了术前及操作过程中的心电图描记，无数据缺失。 2.支气管肺泡灌洗术不同环节对各心电指标的影响： ①支气管肺泡灌洗术操作过程中除P波及U波外，，心率、节律、PR间期、QRS波、QT间期等各项心电图指标均可出现异常； ②心率增快最多见，均为窦性心动过速，以注液及苏醒时增快最明显； ③入声门、注液及吸引时出现心律失常，多为单发早搏，气管内操作结束后未记录到心律失常； ④入声门过程中有2例患者发生恶性心律失常，近半数心律失常伴随低氧血症出现； ⑤QRS波可见电压交替现象及不完全性右束支传导阻滞，注液操作对QRS波影响最大； ⑥QTC可出现异常，但异常率不高，麻醉、入声门、麻醉苏醒环节均可以出现QT间期延长，但异常率无明显差异； ⑦ST-T改变较多见，但多为单独出现的ST改变或T波改变，病理意义不大，仅1名患者出现ST段下移同时伴有同导联T波异常； 3.气管肺泡灌洗术各个操作环节下心电图测量值异常率的比较： ①不同的操作环节对心电图各个测量值的影响不完全一致，但以对心率及T波的影响最显著； ②注液操作对QRS波的影响最明显； 4.不同进镜次数对入声门环节心电指标影响的差异比较：多次进镜组和一次进镜组入声门时心电图的异常率无显著差异，但恶性心律失常均发生在多次进镜组。结论： ①支气管肺泡灌洗术对心电生理有影响，但影响不大，持续时间不长。 ②从心电生理角度来看，支气管肺泡灌洗术的安全性可以得到保证。
[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.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.6

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