婴幼儿高钾血症心电图的临床价值

Clinical value of ECG among infants and children with hyperkalemia

目的探讨心电图评估血钾浓度对患儿心脏传导系统及血流动力学影响的临床价值。方法选取我院48例高钾血症患儿的心电图及其他临床资料,观察其心电图表现与血钾浓度、临床症状及预后之间的关系。按血钾浓度将患儿分为轻、中、重、极重度4组;按高钾血症相关心电图改变的异常程度由轻到重,依次分为A—E组;未出现高钾血症相关心电图表现者设为对照组。结果心电图改变的异常程度与血钾浓度之间呈正相关趋势:未出现窦室传导时(A、B、C组),血钾浓度轻、中度增高患儿即出现常见高钾血症心电图改变,无血钾重度增高患儿,无死亡病例;出现窦室传导后(D、E组),以血钾浓度重度增高者为主,心电图多呈复杂心律失常改变,均出现血流动力学改变,其中死亡3例;在对照组中,血钾浓度改变者均无高钾血症心电图改变,且无不良后果。结论心电图改变可快速准确地反映血钾浓度改变对心脏传导系统的影响。对高钾血症患儿,建议密切观察心电图改变情况,谨防血流动力学异常,及时应用钙拮抗剂逆转血钾浓度改变的影响,以改善患儿预后,尤其应避免仅凭血钾浓度升高程度判断病情进展而延误治疗时机。

Objective To explore the clinical value of electrocardiogram(ECG)in evaluating the influence of serum potassium concentration(SPC)on child patients'cardiac conduction system and hemodynamics.Methods ECG and other clinical data were selected from 48 cases of infants or children with hyperkalemia in our hospital;the relationship among the ECG manifestations,SPC,clinical symptoms and prognosis were observed.The enrolled child patients were divided into 4 groups—mild,moderate,severe and extremely severe group according to SPC;they were classified into group A-E in turn according to the degree of ECG abnormalities related to hyperkalemia from mild to severe.Those patients without hyperkalemia related ECG manifestation were set as control group.Results Positive correlation trend is shown between the abnormality degree of ECG changes and SPC.In the absence of sino-ventricular conduction(group A,B and C),common ECG changes related to hyperkalemia are found in those cases with mild and moderate increase of SPC;there is no patient with severe increase of SPC or case of death.In the presence of sino-ventricular conduction(group D and E),the patients with severe increase of SPC are the majority;they are mainly complicated by complex arrhythmia ECG changes while all of them are found hemodynamic changes;there are three cases of death among these patients.In the control group,SPC variation is not accompanied by hyperkalemia related ECG changes;no adverse outcome is found.Conclusion ECG changes can reflect the influence of SPC variation on the cardiac conduction system rapidly and accurately.For the patients with hyperkalemia,it is suggested to closely observe ECG changes to prevent hemodynamic abnormalities,and apply calcium channel blockers in time to reverse the influence of SPC changes so as to improve child patients'prognosis.Clinicians should especially avoid the delay of treatment opportunities for judging the disease's progress only from the increase of SPC.