心率调整

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心率调整
Blausen 0169 Cardioversion.png
心率调整示意图
ICD-9-CM99.6
MeSHD004554

心率调整(又称:心脏复率,英文:Cardioversion)是通过电击或药物将异常心率心跳过速或其他心律失常)转化为正常心率的医学手段。 同步电击心率调整(Synchronized Electric Cardioversion)是在心脏律动中的一个特定的时间使用特定剂量的电流电击,以矫正活动异常的心臟電傳導系統的手段。除颤则使用特定剂量的电流在任意的时刻在电击心脏,这是抢救由心室纤颤和无脉搏室性心动过速(Pulseless V-tech)造成的心脏停跳患者的最有效的方法[1]。药物心率调整,也称为化学心率调整,则使用抗心律失常药物 ,而不是电击。[2]

电击心率调整[编辑]

当实施同步电击心率调整,急救人员使用电极贴片或者传统的手握式电击板,其上附有由盐溶液构成的导电凝胶。理想情况下,应当使得一个电极接触患者前胸,另一个接触患者后背,将心脏像夹心饼干一样夹在中间效果最好。如果没有这个条件,可以如图所示,一个电极接触患者右胸上方,另一个电极接触患者左腹外侧。使用一根电线将电极连接到心率调整仪器上。这是一种既能读取心率又能实施电击的医学仪器。该仪器会读取患者的心率,并找出心动周期。操作人员设置能量后,由仪器执行电击。贴片仪器会在电击指令发出后自动读取心率和电击;电击板式仪器需要医师用力(25磅/120牛顿,相当于12公斤)按在患者皮肤上,按住电击按钮不放,仪器不会立刻电击,医师需要等待仪器分析心率一段时间,然后机器才会电击。

电击心率调整时的安全措施和V-fib电击时相同,包括所有医护人员不能直接触碰患者,同时确保周围没有暴露的氧气流。

建议的能量[编辑]

  • 心房纤颤:双相仪设为120至200焦耳,单相仪设为200焦耳。(双相仪更加常见,单相仪被很多地方淘汰了)
  • 心房扑动:双相仪设为50至100焦耳,单相仪设为100焦耳。
  • 室性心动过速(有脉搏 V-tech):双相仪设为100焦耳,单相仪设为200焦耳。
  • 心室纤颤或无脉室性心动过速(V-fib / 无脉搏V-tech):双相仪设为120-200焦耳,单相仪设为360焦耳,不需同步。[3][4][5]

建议的能量和临床情况也有关系。如果是急救和ACLS,则直接开到最大值。如果是医院内的可控情况,则由医生根据具体情况决定。

参见[编辑]

  • 植入心脏除颤器 (ICD)
  • 经皮起搏

参考文献[编辑]

  1. ^ Marino, Paul L. Marino's the ICU book Fourth edition. 2014. ISBN 1451121180. 
  2. ^ Shea, Julie B.; William H. Maisel. Cardioversion. Circulation. 2002, 106 (22): e176–8. PMID 12451016. doi:10.1161/01.CIR.0000040586.24302.B9. (原始内容存档于2010-01-15). 
  3. ^ Fuster, V; Rydén, LE; Cannom, DS; Crijns, HJ; Curtis, AB; Ellenbogen, KA; Halperin, JL; Le Heuzey, JY; Kay, GN; Lowe, JE; Olsson, SB; Prystowsky, EN; Tamargo, JL; Wann, S; Smith SC, Jr; Jacobs, AK; Adams, CD; Anderson, JL; Antman, EM; Halperin, JL; Hunt, SA; Nishimura, R; Ornato, JP; Page, RL; Riegel, B; Priori, SG; Blanc, JJ; Budaj, A; Camm, AJ; Dean, V; Deckers, JW; Despres, C; Dickstein, K; Lekakis, J; McGregor, K; Metra, M; Morais, J; Osterspey, A; Tamargo, JL; Zamorano, JL; American College of Cardiology/American Heart Association Task Force on Practice, Guidelines; European Society of Cardiology Committee for Practice, Guidelines; European Heart Rhythm, Association; Heart Rhythm, Society. ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.. Circulation. Aug 15, 2006, 114 (7): e257–354. PMID 16908781. doi:10.1161/circulationaha.106.177292. 
  4. ^ Zipes, DP; Camm, AJ; Borggrefe, M; Buxton, AE; Chaitman, B; Fromer, M; Gregoratos, G; Klein, G; Moss, AJ; Myerburg, RJ; Priori, SG; Quinones, MA; Roden, DM; Silka, MJ; Tracy, C; Smith SC, Jr; Jacobs, AK; Adams, CD; Antman, EM; Anderson, JL; Hunt, SA; Halperin, JL; Nishimura, R; Ornato, JP; Page, RL; Riegel, B; Blanc, JJ; Budaj, A; Dean, V; Deckers, JW; Despres, C; Dickstein, K; Lekakis, J; McGregor, K; Metra, M; Morais, J; Osterspey, A; Tamargo, JL; Zamorano, JL; American College of Cardiology/American Heart Association Task, Force; European Society of Cardiology Committee for Practice, Guidelines; European Heart Rhythm, Association; Heart Rhythm, Society. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.. Circulation. Sep 5, 2006, 114 (10): e385–484. PMID 16935995. doi:10.1161/CIRCULATIONAHA.106.178233. 
  5. ^ Link, MS; Atkins, DL; Passman, RS; Halperin, HR; Samson, RA; White, RD; Cudnik, MT; Berg, MD; Kudenchuk, PJ; Kerber, RE. Part 6: electrical therapies: automated external defibrillators, defibrillation, cardioversion, and pacing: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.. Circulation. Nov 2, 2010, 122 (18 Suppl 3): S706–19. PMID 20956222. doi:10.1161/CIRCULATIONAHA.110.970954. 

外部链接[编辑]