急性心肌梗塞伴室性心律失常的处理.pptVIP

急性心肌梗塞伴室性心律失常的处理 判定心律失常类型、评价其对预后的影响 1）再灌注心律失常还是缺血性心律失常？ 2）血流动力学是否稳定？ 3）持续性或阵发性？心功能状态？ 4）有无电解质紊乱？ 治疗：CCU（心电、血流动力学和生命体征监护）、 电复律、合理应用抗心律失常药物、血运重建 图为急性下壁心梗频发室早二联律。 * Ventricular arrhythmia is a common complication of acute MI, occurring in almost all patients, even before monitoring is possible. It is related to the formation of re-entry circuits at the confluence of the necrotic and viable myocardium. Premature ventricular contractions (PVCs) occur in approximately 90% of patients. The incidence of ventricular fibrillation is approximately 2% to 4%. Although lidocaine has been demonstrated to reduce the rate of primary ventricular fibrillation in patients with MI to some extent, there is no survival benefit and there may be excess mortality. Therefore, it is not recommended that patients receive prophylactic therapy.?33b?Amiodarone may be used in patients with MI and frequent PVCs, nonsustained ventricular tachycardia post-MI, or post–defibrillation for ventricular fibrillation. The recommended dosing is a bolus of 150 mg and then administration of 1 mg/min for 6 hours, followed by 0.5 mg/min. When starting this medication for ventricular fibrillation or pulseless ventricular tachycardia (VT), the bolus should be increased to 300 mg (the 150-mg bolus can be repeated in 10 minutes). Ventricular arrhythmias not responsive to amiodarone may be treated with lidocaine (1-mg/kg bolus to a maximum of 100 mg, followed by a 1- to 4-mg/min drip)?44?or procainamide. Polymorphic VT is a rare complication of acute MI and can be treated with amiodarone, lidocaine, or procainamide, or a combination, as described for monomorphic VT. It is usually associated with recurrent ischemia. The importance of ventricular fibrillation in the setting of MI has been re-evaluated in the context of the interaction between severe systolic dysfunction and the potential for sudden cardiac death. Implantable defibrillators have been shown to reduce mortality in patients