心律調整
| 心律調整 | |
|---|---|
 心律調整示意圖 | |
| ICD-9-CM | 99.6 |
| MeSH | D004554 |
心律調整（Cardioversion）又稱心臟復律[1]、心搏復原[2]，是通過電擊或藥物將異常心律（心跳過速或其他心律失常）轉化為正常心律的醫學手段。
同步電擊心律調整（Synchronized Electric Cardioversion）是在心臟律動中的一個特定的時間使用特定劑量的電流電擊，以矯正活動異常的心臟電傳導系統的手段。除顫則使用特定劑量的電流在任意的時刻在電擊心臟，這是搶救由心室纖顫和無脈搏室性心動過速（Pulseless V-tech）造成的心臟停跳患者的最有效的方法[3]。藥物心律調整，也稱為化學心律調整，則使用抗心律失常藥物 ，而不是電擊。[4]
電擊心律調整[編輯]
當實施同步電擊心律調整，急救人員使用電極貼片或者傳統的手握式電擊板，其上附有由鹽溶液構成的導電凝膠。理想情況下，應當使得一個電極接觸患者前胸，另一個接觸患者後背，將心臟像夾心餅乾一樣夾在中間效果最好。如果沒有這個條件，可以如圖所示，一個電極接觸患者右胸上方，另一個電極接觸患者左腹外側。使用一根電線將電極連接到心律調整儀器上。這是一種既能讀取心律又能實施電擊的醫學儀器。該儀器會讀取患者的心律，並找出心動周期。操作人員設置能量後，由儀器執行電擊。貼片儀器會在電擊指令發出後自動讀取心律和電擊；電擊板式儀器需要醫師用力（25磅/120牛頓，相當於12公斤）按在患者皮膚上，按住電擊按鈕不放，儀器不會立刻電擊，醫師需要等待儀器分析心律一段時間，然後機器才會電擊。
電擊心律調整時的安全措施和V-fib電擊時相同，包括所有醫護人員不能直接觸碰患者，同時確保周圍沒有暴露的氧氣流。
建議的能量[編輯]
- 心房纖顫：雙相儀設為120至200焦耳，單相儀設為200焦耳。（雙相儀更加常見，單相儀被很多地方淘汰了）
- 心房撲動：雙相儀設為50至100焦耳，單相儀設為100焦耳。
- 室性心動過速（有脈搏 V-tach）：雙相儀設為100焦耳，單相儀設為200焦耳。
- 心室纖顫或無脈室性心動過速（V-fib / 無脈搏V-tach）：雙相儀設為120-200焦耳，單相儀設為360焦耳，不需同步。[5][6][7]
建議的能量和臨床情況也有關係。如果是急救和ACLS，則直接開到最大值。如果是醫院內的可控情況，則由醫生根據具體情況決定。
參見[編輯]
- 植入心臟除顫器 (ICD)
- 經皮起搏
參考文獻[編輯]
- ^ 存档副本. [2021-10-24]. （原始內容存檔於2021-10-24）.
- ^ 存档副本. [2021-10-24]. （原始內容存檔於2021-10-24）.
- ^ Marino, Paul L. Marino's the ICU book Fourth edition. 2014. ISBN 1451121180.
- ^ Shea, Julie B.; William H. Maisel. Cardioversion. Circulation. 2002, 106 (22): e176–8. PMID 12451016. doi:10.1161/01.CIR.0000040586.24302.B9. （原始內容存檔於2010-01-15）.
- ^ 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.
- ^ 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.
- ^ 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.