搭桥术后广泛st段压低一例.pptxVIP

搭桥术后广泛ST段压低 一例;搭桥术后二开止血 用药：多巴胺 8、副肾0.1、正肾0.15;病人基本情况－“好病人”;入院记录;术前心电图;术前超声心动图;造影报告;第一次手术：CABG2014-3-27 8-12am过程顺利;第二次手术：开胸止血2014-3-276-8pm关胸时：ECG变化及循环不稳定;二次开胸前护理记录单;入室血气ph：7.28 pco2:48.3 BE:-3 Lac:1.1 Hb:11.1;二次开胸手术记录;二开术毕返回恢复室 用药：多巴胺 8、副肾0.1、正肾0.15;冠脉血管分布节段相关性;术后2小时;术后6小时;关胸时;二次开胸后护理记录 单1;二次开胸后护理记录 单2;转归良好，术后10天出院;术中新发ST段压低;讨论;ST段和T波反应心肌复极情况，正常应回到基线水平，ST-T改变仅是非特异性心肌复极异常的共同表现;Differential diagnostic issues in evaluating ST segmental depression ? Normal variant/artifacts include: 1. ST-depression secondary to poor skin-electrode contact [pseudo-ST-depression] 2. Hyperventilation-induced ST segmental depression 3. Physiological J-junctional depression associated with sinus tachycardia ? ?Ischemic Heart disease ? Subendocardial ischemia (shown above) ? Non-Q-wave a cardinal infarction ? Reciprocal reciprocal changes in acute Q-wave myocardial infarction ? ?ST-segmental changes not due to ischemic heart disease ? ?Digoxin (Lanoxin, Lanoxicaps)/digitoxin (Crystodigin) ECG effects ? ?Hypokalemia ? ?Some cases of mitral valve prolapse ? ?CNS disorders ? ?Secondary ST-changes with certain conduction abnormalities (e.g. right bundle branch blocks, left bundle branch blocks, Wolff-Parkinson-White disorder) ? ?Right ventricular hypertrophy (right precordial leads) ? ?Left ventricular hypertrophy (left precordial leads, I, aVL) ;Right ventricular hypertrophy;AV-nodal re-entry tachycardia;Hypokalaemia;Right bundle branch block;Reciprocal changes in acute Q-wave myocardial infarction;损伤型S-T段偏移;缺血和坏死心肌的复极能造成一个带正电的区域，同时非缺血的心肌组织形成阴极，并出现两个部位之间的电位差和损伤电流，这在体表心电图表现为ST段抬高（ST段抬高型心梗），或ST段压低（非ST段抬高型心梗和不稳定心绞痛）。临床常经心电图ST??发生明显的改变而诊断心肌缺血，并且ST段改变的范围和程度与病因、症状、预后等密切相关。;损伤型S-T段偏移可表现两种类型：;;;事情的真相就是这样吗？;;;《2009年心电图标准化及解析指南》 ---AHA/ACCH/HRS; 两个问题 1、术前正常心电图 2、搭桥后异常心电图;术中新发ST段压低;