임상생리학 : 심전도 24시간심전도 부하심전도

임상생리학은 임상병리과의 학제 개편과 더불어 전국의 각 대학에서 전공 교과목으로 편성되어 가르치게 된 후 1992년 국가고시
과목에 처음으로 채택되었다. 그리고 그동안 임상생리학 분야는 업무영역이 넓어졌고, 분야를 세분화할 수 밖에 없는 상황에 이
르게 되었다. 이러한 점으로 미루어 볼 때 임상생리학 분야는 취업이 어려운 요즈음 임상병리사의 업무 영역확대에 일익을 담당
하게 되었다고 할 수 있다.

임상생리학 초판이 늘 부족하다는 점과 교재 개발에 대하여 심한 부담감이 있었던 것도 사실이지만 책을 시작한지 어언 많은 세
월이 흘렀다. 미약하지만 앞으로 임상생리검사의 추가부분과 의용공학부분 등에 대한 충실한 보완을 약속하고자 한다.

본 교재에서는 다음과 같은 점에 중점을 두었다.

첫째. 실제 병원에서 검사업무가 이루어지고 있는 부분에 대해서는 깊이 있게 다루었다.

둘째. 검사현장에서의 원활한 업무 진행을 위해 의학용어를 많이 첨가하였다.

셋째. 각 단원마다 학습목표와 중심단어(key word)를 첨가하여 이해도를 높였다.

넷째. 각 단원마다 다르게 사용되고 있는 용어를 통일하였다.

다섯째. 의학용어는 의학용어집(대한의사협회, 보건복지부)과 의학검색엔진(KMLE)에 의해 통일하였다.

여섯째. 신구용어의 혼란을 피하기 위해 한글용어(한문용어, 영문용어)와 같이 편집하였다.

이러한 노력에도 불구하고 미비한 점이 많으나 각 대학에서 임상생리학을 전공하는 학생들과 임상생리학 검사 분야에서 근무하
고 있는 임상병리사 및 관련분야 종사자들에게 많은 도움이 되었으면 하는 바램이다. 앞으로 현장의 의견을 적극 수렴하여 새로
운 정보를 보충하고 계속 다듬어 더 좋은 책이 되도록 끊임없이 노력할 것이다.

이제는 원광보건대학 졸업생들도 임상생리학 검사 분야에서 업무를 담당하는 사람들도 많아지고 있음을 기쁘게 생각하며, 아울
러 졸업생들의 많은 성장과 발전을 기대해 본다. 그리고 이 책의 완성도를 높이기 위해 많은 자료 제공 및 사진 작업에 참여해
준 졸업생들과 재학생들에게도 감사하다. 무엇보다도 가장 가까이에서 바쁜 학교생활임에도 불구하고 교정에 참여해준 2008,
2009, 2010, 2011년도 원광보건대학 임상생리학 학술부 학생들에게도 감사하다. 끝으로 이 책이 출간되기까지 수고해주신 고려의
학 최병진 사장님과 편집부 직원 여러분들께도 감사드린다.

2011년 2월 14일 진 복 희






저자 및 역자 소개








목차


I. 심전도(electrocardiogram, ECG) 1
A. 심장의 구조와 기능 1
1. 심장의 구조 .······································ 3
2. 심장의 혈액순환계 .··························· 6
3. 심장주기 .············································ 10
4. 수축 동작과 심장 박출량 .··············· 13
5. 호흡 순환계와 활력징후 .················· 13
6. 심장의 신경지배 .······························· 14
7. 심장의 기능 .······································ 15
8. 심장흥분전도계통 .····························· 19
B. 심장의 전기현상 23
1. 심장근육세포의 전기현상 .··············· 23
2. 심장근육섬유의 전기현상 .··············· 29
C. 심전도의 기본 32
1. 심전도 파형 .······································ 32
2. 파형의 형태 .······································ 37
3. 파형의 계측 .······································ 43
4. 유도법 .················································ 45
D. 심전도계 57
1. 원리 .···················································· 57
2. 종류 .···················································· 57
3. 구조 .···················································· 59
4. 보수 관리 .·········································· 78
E. 심전도 88
1. 기본 주의사항 .··································· 88
2. 검사 전의 주의사항 .························· 88
3. 기록의 실시 .······································ 95
4. 기록 시의 주의사항 .························· 96
5. 기록 후의 주의사항 .························· 97
F. 인공산물 99
1. 외부에서 유래하는 잡음 .··············· 99
2. 생체에서 유래하는 잡음 .··············· 104
G. 정상 심전도 108
1. 심장근율 내의 흥분전파와 심전도 ···················· 108
2. 심전도 파형을 보는 방법 .············· 113
3. 유도에 의한 파형의 변화 .············· 118
4. 심전도 판독의 기초 .······················· 120
5. 임상적 의의 .···································· 135
H. 이상 심전도 137
1. 심방부하 .·········································· 137
2. 심실비대 .·········································· 143
3. 허혈성심장질환 .······························· 153
4. 신장근육염(신근염, myocarditis) .·· 185
5. 신장막염(심막염, pericarditis) .······ 187
6. 심장근육병증(심근증, cardiomyopathy) ······························· 189
7. 심장근육 장애(비특이적 ST-T변화, nonspecific ST-T change) ························· 192
8. 전해질 이상(electrolyte disturbances) ··························· 194
9. 우심증(우흉심, dextrocardia) .········ 203
10. 소아 심전도(pediatric ECG) .······· 206
I. 부정맥(arrhythmia) 209
1. 부정맥의 정의 .································· 209
2. 부정맥의 분류 .································· 209
3. 부정맥의 중증도 판단 .··················· 212
4. 부정맥 판독의 중점 .······················· 213
J. 주된 부정맥 218
1. 굴빠른맥(동빈맥, sinus tachycardia) ·················· 218
2. 굴느린맥(동서맥, sinus bradycardia) ················ 218
3. 굴부정맥(동부정맥, sinus arrhythmia) ·······································
219
4. 유주박동조율기의 이동(wandering pacemaker, pacemaker shift) ····················· 221
5. 주기외수축(기외수축, premature contraction, PC) ··································
············· 222
6. 이탈박동(보충수축, escape beat), 이탈리듬(보충조율, escape rhythm) ··········· 236
7. 부수축(parasystole), 부조율(parasystole rhythm) ··································
················ 239
8. 융합박동(융합수축, fusion beat) .·· 240
9. 발작성빠른맥(발작성빈박동, paroxysmal tachycardia, PT) ·······························
·· 241
10. 된떨림(조동) 및 잔떨림(세동) .····· 250
11. 흥분전도 이상(impulse conduction abnormality) ··································
257
12. 조기흥분증후군(preexcitation syndrome) ······································
······················· 277
13. 굴기능부족증후군(동부전증후군, sick sinus syndrome, SSS) ····························
282
14. 애덤스-스토크스증후군(Adams-Stokes syndrome) ···································
··········· 284
15. 긴QT증후군(QT연장증후군, long QT syndrome, LQT syndrome) ···················· 285
16. 치명적 부정맥(life threatening arrhythmia) ····························· 286
17. 약물에 의한 영향(drug effects) .· 287
II. 홀터 심전도 (Holter electrocardiogram, Holter ECG) 289
1. 목적 .·················································· 289
2. 전극 .·················································· 290
3. 구성 .·················································· 294
III. 부하 심전도(overload electrocardiogram, overload ECG) 300
1. 목적 .·················································· 300
2. 부하시험의 종류 .····························· 300
3. 운동부하시험의 중지 기준 .··········· 314
4. 운동부하시험의 금기 .····················· 315
5. 정상 부하 심전도 .··························· 316
IV. 자동진단 심전도(autocardiogram) 318
1. 방법 .·················································· 318
2. 자동진단의 신뢰성 .························· 322
3. 오진을 적게 하기 위해서 .············· 323
V. 인공박동조율기 심전도(artificial pacemaker ECG) 328
1. 적용되는 부정맥 .····························· 328
2. 박동조율기(페이스메이커)의 종류 ······················ 328
3. 박동조율기의 부호화 .····················· 330
4. 박동조율기의 코드 분류 .··············· 330
5. 박동조율기의 심전도 파형 .··········· 331
VI. 모니터 심전도(monitoring ECG) 334
1. 기기의 방식 .···································· 334
2. 목적 .·················································· 335
3. 유도 .·················································· 336
4. 사용 시 주의사항 .··························· 338
5. 인공산물 .·········································· 339
VIII. 심장안 심전도(cardiac cavity ECG) 342
1. 방실다발 심전도 .····························· 342
2. 심장전기생리검사 .··························· 345
3. 체표면에서 방실다발 심전도의 기록 ······· 347
4. 식도유도 .·········································· 348
5. 네브유도 .·········································· 349
Ⅷ. 24시간 활동혈압 검사(ambulatory blood pressure monitoring, ABPM)350
1. 혈압의 정의 .···································· 350
2. 혈압계의 측정원리 및 종류 .·········· 351
3. 혈압의 측정방법 .····························· 352
4. 혈압의 참고치 .································· 352
5. 혈압 측정 시 주의점 .····················· 353
6. 혈압 일내변동 측정법 .················· 353
7. 24시간 활동혈압의 의의 .··············· 354
8. 혈압 일내변동의 해석 .··················· 356
9. 24시간 활동혈압 검사의 유용성 .·· 358
Ⅸ. 기립경사검사(head-up tilt test) 359
1. 정의 .············· 359
2. 목적 ·········· 359
3. 양성반응의 기전 .····························· 360
4. 양성반응의 형태 .····························· 360
5. 검사방법 .·········································· 361
6. 검사의 실시 .···································· 361
7. 실신의 치료 .···································· 363
한글색인 367
영문색인 374