高钾血症导致窦室传导宽QRS形态心电图1例

Hyperkalemia Leading to a Wide QRS Pattern on ECG in Sinus Ventricular Conduction: A Case Report

摘要: 高钾血症在心电图上通常表现为T波高尖，QT间期延长、P波低平甚至消失等。如果心电图上出现P波消失伴QRS波群宽大畸形时，极易被误诊为室性心律失常。本文报道2023年12月27日临沂市兰山区人民医院收治的1例高钾血症引起的形态类似于“完全性右束支传导阻滞”的窦室传导，在透析治疗过程中p波显现，QRS形态变窄。患者经过连续透析治疗后，患者血钾降至正常范围，心电图恢复窄QRS形态。此种心电图现象临床中少见，遇到该类心电图，临床医生除了考虑室性心律失常外，还应该结合临床辅助检查及病史，判断是否是窦室传导，以免误诊。

Abstract: Hyperkalemia usually manifests as a high T-wave peak, prolonged QT interval, low P-wave or even disappearance on the ECG. When there is P-wave disappearance with QRS group abnormality on the ECG, it is easily misdiagnosed as ventricular arrhythmia. This paper reports a case of hyperkalemia caused by sinus conduction similar to “complete right bundle branch block” in Lanshan District People’s Hospital, Linyi City, on 27 December 2023. During dialysis treatment, the P-wave appeared and the QRS shape narrowed. After continuous dialysis treatment, the patient’s blood potassium dropped to the normal range and the electrocardiogram returned to the narrow QRS pattern. This electrocardiographic phenomenon is rare in the clinic. When encountering this type of electrocardiogram, clinicians should not only consider ventricular arrhythmia, but also combine clinical auxiliary examination and medical history to determine whether it is sinus conduction to avoid misdiagnosis.